维持性血液透析患者腹主动脉钙化进展的危险因素分析

Risk factors for progression of aortic arch calcification in patients on maintenance hemodialysis

目的探讨维持性血液透析（MHD）患者腹主动脉钙化（AAC）进展的危险因素。方法纳入2014年6月至2014年10月在天津医科大学第二医院接受MHD的170例患者为研究对象。腹部侧位X线片评估腹主动脉钙化积分（AACscore，AACs），随访2年后再次评估患者AACs。根据AACs变化情况分为AAC快速进展组和非AAC快速进展组。采用Logistic回归方程分析腹主动脉钙化进展的危险因素。结果MHD患者基线AAC（AACs≥1）发生率为43．5％（74／170）。平均随访时间27．6（24．7，28．0）个月，再次接受AACs评估的患者111例，AAC发生率为78．4％（87／111）。其中新发AAC36例，AAC快速进展组54例，非快速进展组57例。多因素Logistic回归分析结果提示，高磷血症（OR=12．618，95％C1为2．912～54．666，P=0．001），血高密度脂蛋白胆固醇水平低（OR=0．031，95％CI为0．003～0．338，P=0．004）是腹主动脉钙化进展的独立危险因素。结论高磷血症、血高密度脂蛋白胆固醇水平低可能加速MHD患者腹主动脉钙化。调整血磷和脂代谢可延缓MHD患者血管钙化的进展，降低心血管疾病和死亡风险。

Objective To investigate the possible risk factors for the progression of abdominal aortic calcification （AAC） in MHD patients. Methods Total of 170 patients on MHD between June 2014 and October 2014 in the dialysis center of the Second Hospital of Tianjin Medical University were included prospectively. Lateral lumbar radiography were applied to evaluate patients＂ AAC score （AACs） at baseline and after two-years of follow-up respectively. According to the change of AACs, the patients were divided into rapid AAC progression group and nonrapid AAC progression group. Muhivariable Logistic regression models were used to determine the risk factors for the progression of AAC in MHD patients. Results At baseline, the presence of AAC （AACs≥1） was 43.5%（74/170）. The mean followup duration was 27.6（24.7, 28.0） months. AACs were available in 111 patients, and the presence of AAC was 78.4%（87/111）. During the follow up, 36 patients developed new AAC; rapid AAC progression was seen in 54 patients, and non-rapid AAC progression was seen in 57 patients. Multivariate Logistic regression analysis demonstrated that hyperphosphatemia （OR=4.373,95% CI 1.562-7.246, P=0.005） and high density lipoprotein （HDL） （OR=0.031, 95%CI 0.003-0.338, P=0.004） were independent risk factors for AAC progression in MHD patients. Conclusions Hyperphosphatemia and low HDL may promote the progression of AAC. Wellcontrolled serum phosphate and lipid metabolism may slow the progression of vascular calcification, reducing cardiovascular morbidity and mortality.