维持性血液透析患者镁代谢紊乱与冠状动脉钙化的相关性分析

Relationship between serum magnesium level and coronary artery calcification in maintenance hemodialysis patients

目的探讨维持性血液透析（MHD）患者镁代谢紊乱及冠状动脉钙化（CAC）的相关影响因素。方法病例来自2014年12月至2015年12月在本院血液透析中心行MHD治疗的131例患者，收集入选患者的临床资料和血生化资料，酶联免疫吸附法（ELISA）测定血清成纤维细胞生长因子23（FGF-23）水平，多层螺旋计算机断层扫描（MSCT）测定冠状动脉钙化积分（CACs），分析各组MHD患者血镁水平与相关临床资料、血生化资料、FGF-23水平及CACs的相关关系。结果入选131例MHD患者按照血镁水平高低分为低血镁组、正常血镁组和高血镁组，各组患者在糖尿病病史、血磷、白蛋白、前白蛋白、血尿酸水平方面比较，差异有统计学意义（P〈0．05）；Pearson相关分析及Spearman相关分析显示，血镁水平与血白蛋白、血前白蛋白、血磷、血尿酸呈正相关（r分别为0．389、0．234、0．200、0．234，P值分别为0．000、0．007、0．022、0．007）。根据冠状动脉钙化程度将所有MHD患者分成无钙化组、轻度钙化组、中度钙化组及重度钙化组，各组间年龄、血磷、血镁、FGF-23水平差异有统计学意义（Pc0．05）。Spearman相关分析显示，MHD患者CACs与年龄、FGF-23、血磷呈正相关（r分别为0．309、0．277、0．180，P值分别为0．000、0．001、0．040），与血镁水平呈负相关（r=0．238，P：0．006）。多分类有序Logistic回归分析显示，MHD患者CAC程度的独立危险因素有高龄、高水平FGF-23，而高血镁是保护因素。结论MHD患者中糖尿病病史、低白蛋白血症、磷代谢紊乱、CAC与低镁血症发生相关。CAC程度的独立危险因素有高龄、高水平FGF．23，而高血镁是保护因素。

Objective To evaluate the relationship between serum magnesium and coronary artery calcification （CAC） and their associated factors. Methods 131 patients with chronic kidney disease on regular hemodialysis （HD） were recruited into this study from December 2014 to December 2015 in our center. Demographic and clinical data of selected patients were collected. Serum fibroblast growth factor 23 （FGF- 23） level was quantified by enzyme linked immunosorbent assay（ELISA）. Quantification of coronary artery calcification score （CACs） was determined by multi- slice spiral computed tomography （MSCT）. The relationships between serum magnesium and FGF-23 level, CACs, demographic and clinical data were investigated. Results Patients were divided into low serum magnesium group, normal serum magnesium group and high serum magnesium group according to their serum magnesium levels. There were significant differences in the distribution of diabetes history,serum phosphorus, serum albumin, serum pre albumin, serum uric acid among these three groups（P 〈 0.05）. A significant positive correlation was confirmed between serum magnesium level and serum albumin, serum pre albumin, serum phosphorus and serum uric acid by Pearson correlation analysis and Spearman correlation analysis （r=0.389, 0.234, 0.200, 0.234, P=0.000, 0.007, 0.022, 0.007, respectively）. According to the degree of CAC, all maintenance hemodialysis （MHD） patients were divided into non- calcification group, low calcification group, moderate calcification group and high calcification group, and there were significant differences in the distribution of the age, serum phosphorus, serum magnesium, FGF-23 levels among these groups （P 〈 0.05） . Spearman correlation analysis showed that CACs was positively correlated with age, FGF-23, serum phosphorus （r=0.309, 0.277, 0.180, P=O.O00, 0.001, 0.040, respectively）, while negatively correlated with serum magnesium level （r=-0.238, P=0.006） in patients with MHD. The independent risk factors of CACs were aging, high level of FGF-23 in MHD patients by using ordinal logistic regression. However, Hypermagnesemia was a protective factor. Conclusions The history of diabetes, low serum albumin, phosphorus metabolism disorder and CAC are associated with hypomagnesemia in MHD patients. In MHD patients, aging as well as high level of FGF-23 are the risk factors of CAC, and hypermagnesemia is a protective factor of CAC.