心脏瓣膜钙化对终末期肾病患者腹主动脉钙化的预测价值

Value of cardiac valve calcification in predicting abdominal aorta calcification in patients with end-stage renal disease

目的探讨心脏瓣膜钙化对终末期肾病维持性血液透析患者腹主动脉钙化的预测价值。方法选取131例慢性肾病血液透析患者,行超声心动图检查评价心脏瓣膜钙化评分(CVCS),采用腹部侧位X射线平片评判腹主动脉钙化积分(AACS),分析患者生化结果以及透析相关指标。分析CVCS与AACS之间的相关性。Logistic回归方法分析血液透析患者发生心脏瓣膜钙化和腹主动脉钙化的危险因素。结果 131例中,诊断心脏瓣膜钙化53例(心脏瓣膜钙化组),无心脏瓣膜钙化78例(无心脏瓣膜钙化组),有腹主动脉钙化57例。心脏瓣膜钙化组患者年龄、BMI、透析时间、全段甲状旁腺激素水平均高于无心脏瓣膜钙化组(P<0.05),而白蛋白低于无心脏瓣膜钙化组(P<0.05)。Pearson相关分析显示,患者CVCS与AACS呈正相关(r=0.535,P<0.01)。Logistic回归分析显示,CVCS高、年龄大和透析时间长是腹主动脉钙化发生的独立危险因素,而HDL升高是腹主动脉钙化发生的独立保护因素(P<0.01)。应用心血管危险因素结合CVCS的方法预测腹主动脉钙化发生的ROC曲线下面积为0.880[95%CI(0.817～0.942)]。结论维持性血液透析患者普遍存在心脏瓣膜及腹主动脉钙化,心脏瓣膜钙化越严重,透析时间越长,发生腹主动脉钙化的风险也越高。心血管危险因素结合CVCS能够很好地预测维持性血液透析患者腹主动脉钙化的发生。

Objective To investigate the value of cardiac valve calcification in predicting abdominal aorta calcification in the patients with end-stage renal disease.Methods The cardiac valve calcification score（CVCS）by echocardiography and abdominal aortic calcification score（AACS）by lateral X-ray radiography were performed in 131 maintenance hemodialysis patients with chronic kidney disease.The biochemical and dialysis-related parameters were analyzed.The correlation between CVCS and AACS was analyzed.Logistic regression analysis was used to analyze the risk factors for cardiac valve calcification and abdominal aortic calcification.Results Of 131 patients,53 cases were with valve calcification（group A）,78 cases were without valve calcification（group B）and57 cases had abdominal aortic calcification.The age,BMI,dialysis time and intact parathyroid hormone levels were higher,while albumin was lower,in group A than those in group B（P〈0.05）.Pearson correlation analysis showed that CVCS was positively correlated with AACS（r=0.535,P〈0.01）.Logistic regression analysis showed that the higher CVCS,older age and longer dialysis time were the independent risk factors for abdominal aorta calcification,and the higher HDL was an independent protective factor for abdominal aorta calcification（P〈0.01）.The area under the ROC curve of the cardiovascular risk factors combined with CVCS in predicting the occurrence of abdominal aortic calcification was 0.880 [95%CI（0.817-0.942）].Conclusion The calcifications of the cardiac valve and abdominal aortic commonly exist in the patients undergoing maintenance hemodialysis.The more severe cardiac valve calcification and the longer dialysis time,the higher risk for abdominal aortic calcification.The combined analysis of cardiovascular risk factors and CVCS can well predict the occurrence of abdominal aortic calcification in the patients undergoing maintenance hemodialysis.