维持性血液透析患者合并血管钙化情况的观察

Observation of maintenance hemodialysis patients complicated with vascular calcification

目的分析维持性血液透析(MHD)患者的主动脉情况,探讨导致患者血管钙化的危险因素。方法选择114例MHD患者,行腹部侧位X线平片检查,计算患者的腹主动脉钙化(AAC)积分,按照积分结果将MHD患者分为无或轻度钙化组和中或重度钙化组,分别检测2组患者的总胆固醇、血清肌酐、血铁、全段甲状旁腺素、血糖、血钙、血磷等指标,计算校正钙,统计透析龄和年龄、性别构成等数据。采用Logistic回归分析MHD患者血管钙化的影响因素,将单因素分析P<0.10的因素纳入多因素分析。结果 114例MHD患者中,纳入无或轻度钙化组80例,中或重度钙化组34例。与无或轻度钙化组MHD患者比较,中或重度钙化组MHD患者的年龄较大,组间比较差异有统计学意义(P<0.05)。单因素Logistic回归显示患者的年龄、校正钙和血糖水平与血管钙化可能有关(P均<0.10)。把单因素分析P<0.10的3个指标以及性别、钙磷乘积、PTH、透析龄纳入多因素Logistic回归分析,结果显示MHD患者的年龄、校正钙、钙磷乘积与血管钙化程度呈正相关(P均<0.05)。结论 MHD患者的年龄、校正钙、钙磷乘积是血管钙化的危险因素,降低患者的血钙水平可能是减轻患者血管钙化程度的重要方式。

Objective To investigate the risk factors of vascular calcification through analyzing the aorta status of the maintenance hemodialysis( MHD) patients. Methods In total,114 MHD patients received lateral plain X-ray of the abdomen. The score of abdominal aorta calcification( AAC) was calculated. According to the AAC score,all MHD patients were divided into the no or mild calcification group,and moderate or severe calcification group. The levels of total cholesterol,serum creatinine,serum iron,intact parathyroid hormone,blood glucose,blood calcium and blood phosphorous were quantitatively measured in two groups. The corrected calcium,dialysis vintage,age and gender composition were calculated. The risk factors of vascular calcification in MHD patients were analyzed by logistic regression analysis. The factors with P < 0. 10 analyzed by uni-variate logistic regression were included into multi-variate logistic regression analysis. Results Among114 MHD patients,80 patients were assigned into the no or mild calcification group and 34 into the moderate or severe calcification group. Compared with the no or mild calcification group,the age of MHD patients was significantly older in the moderate or severe calcification group( P < 0. 05). Uni-variate logistic regression analysis revealed that the age,corrected calcium and blood glucose level were probably correlated with the incidence of vascular calcification( all P < 0. 10). Three parameters with statistical significance by uni-variate logistic regression,along with gender,product of calcium and phosphorus,PTH and dialysis vintage were included into the multi-variate logistic regression analysis. The statistical results demonstrated that the age,corrected calcium and product of calcium and phosphorus were positively correlated with the severity of vascular calcification( all P < 0. 05). Conclusions The age,corrected calcium and product of calcium and phosphorus of MHD patients are the risk factors of vascular calcification. Lowering the blood calcium level is probably a vital approach to mitigate the severity of vascular calcification in MHD patients.