维持性腹膜透析患者血管钙化的发生情况与相关因素研究

The incidence and related factors of vascular calcification in patients with maintenance peritoneal dialysis

目的本研究旨在探讨维持性腹膜透析(MPD)患者血管钙化的发病率、发病特点、钙化发生的严重程度及相关影响因素。方法选择2014年3月至2017年9月泰兴市人民医院收治的维持性腹膜透析患者108例,男58例,女50例,年龄25~78岁,透析龄>3个月。通过侧位腹平片、骨盆正位片、双手正位X线片评价腹主动脉、髂动脉和股动脉、桡动脉和手指动脉的血管钙化,两位放射科医师盲法阅片及评分。收集人选患者的一般资料,同时检测血钙、血磷、全段甲状旁腺激素、碱性磷酸酶、血红蛋白、白蛋白、血脂、透析充分性等指标。通过血管钙化检测,分为钙化组(n=76)和非钙化组(n=32)。结果108例MPD患者总血钙钙化率为70.37%(76/108),其中高龄(>65岁)患者42例,占55.26%(36/67),糖尿病肾病患者25例,占32.89%(25/76)。钙化部位以腹主动脉者,为73.68%(56/76),髂动脉和股动脉钙化者为59.21%(45/76),桡动脉和手指动钙脉化者为39.47%(30/76)。两组比较,在原发病方面,钙化组糖尿病肾病比例较非钙化组高(P<0.05);钙化组男性比例、高龄、透析时间高于非钙化组(P<0.0 5);钙化组血Ca、P、iPTH、AKP、Tch、T G高于非钙化组,而PA、Alb、残肾Kt/V、残余肾功能低于非钙化组(P<0.0 5)。logistic多因素分析显示,糖尿病肾病、高龄(>6 5岁)、透析龄长、P、iPTH、糖尿病肾病是血管钙化的独立危险因素(P<0.0 5)。血管钙化程度分析,中、重度血管钙化患者比例高,分别为3 0.2 6%、38.16%;与轻度钙化的患者相比,中、重度血管钙化的患者中高龄、男性更多,糖尿病肾病患者更多(P<0.05).logistic多因素分析显示高龄、糖尿病肾病是影响血管钙化发生程度的独立危险因素(P<0.05)。结论MPD患者血管钙化最常发生于腹主动脉。高龄、透析龄长、男性、糖尿病肾病、P、iPTH是血管钙化的危险因素。而在血管钙化的患者中,高龄、男性更多,糖尿病肾病患者血管钙化的程度更重。高龄、糖尿病肾病是影响血管钙化发生程度的独立危险因素。

Objective To investigate the incidence and characteristics of vascular calcification in patients with maintenance peritoneal dialysis ( MPD), the severity of calcification and the related factors. Methods From March 2014 to September 2017 , 108 patients with maintenance peritoneal dialysis admitted to our hospital were selected(58 cases of males and 50 cases of females),25 -78 years old, and the age of dialysis was more than 6 months. The vascular calcification of abdominal aorta, iliac artery, femoral artery, radial artery and finger artery were evaluated by lateral abdominal plain film,pelvis positive radiograph and two handed radiograph. The indexes of blood calcium, blood phosphorus, total parathyroid hormone, alkaline phosphatase, hemoglobin, albumin, blood lipid and dialysis adequacy were collected and measured. All patients were divided into calcified group(n = 76) and non - calcified group( n = 32). Results The total calcium calcification rate in 108 patients with MPD was 70. 37%(76/108), of which 42 cases (>65 years o ld ), accounting for 55. 26%(42/76), 25 cases of diabetic nephropathy, 32. 89%(25 /76 ). The calcification site was dominated by abdominal aorta, 73. 68%(56/76), 59. 21%(45/76) for iliac artery and femoral artery calcification, 39. 47%(30 / 76) in radial artery and finger arterioles. Comparison between two groups, in primary disease, the proportion of diabetic nephropathy in calcified group was higher than that in non-calcification group(P< 0. 05), and the proportion of male, advanced age and dialysis time in calcified group were higher than those in non-calcified group ( P < 0. 05 ). The blood Ca, P , iPTH, AKP, Tch and TG in calcified group were higher than those in non-calcified group, while the PA, Alb, residual kidney Kt/V, residual renal function was lower than that of non-calcified group ( P <0. 05). Logistic multivariate analysis showed that diabetic nephropathy, advanced age ( age > 65), dialysate age, P, iPTH, diabetic nephropathy, residual renal function were independent risk factors for vascular calcification ( P <0. 05). Analysis of the degree of vascular calcification, the proportion of patients with moderate and severe vascular calcification was high, 30. 26% and 38. 16%, respectively. Compared with the patients with mild calcification, patients with moderate and severe vascular calcification in the elderly, more men, more patients with diabetic nephropathy ( P < 0. 05 ). Logistic multivariate analysis showed that advanced age and diabetic nephropathy were independent risk factors for the occurrence of vascular calcification ( P < 0. 05). Conclusions Vascular calcification in patients with MPD often attributed to the abdominal aorta. Advanced age, longer dialysate age, male, diabetic nephropathy, P, iPTH are risk factors for vascular calcification. While in patients with vascular calcification, the elderly and men are more, diabetic nephropathy patients with more serious degree of vascular calcification. Advanced age and diabetic nephropathy are independent risk factors for the occurrence of vascular calcification.