冠状动脉钙化积分对于透析患者心血管事件发生风险的预测价值

The predictive value of coronary artery calcification score for cardiovascular event risk in dialysis patients

目的探究冠状动脉钙化积分对于透析患者心血管事件发生风险的预测价值。方法选取宁波市鄞州区第二医院2016年1月-2017年6月间进行维持性血液透析(MHD)治疗的患者148例,根据观察期(18个月)内是否发生心血管事件分为观察组与对照组,比较2组一般资料、生命体征、血生化检查、冠状动脉钙化积分、Framingham危险评分及EuroSCOREⅡ评分结果,应用ROC曲线评估不同模型预测心血管事件发生的预测效能。结果本研究共发生心血管事件61例(41.22%),观察组与对照组在总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、高密度肌钙蛋白、B型利钠肽及肾小球滤过率(glomerular filtration rate,GFR)方面差异有统计学意义(均P<0.05),观察组冠状动脉钙化积分显著高于对照组(t=7.714,P<0.001),2组Framingham危险评分及EuroSCOREⅡ评分差异有统计学意义(Z=6.288、5.003;均P<0.001)。冠状动脉钙化积分、Framingham危险评分及EuroSCOREⅡ评分预测心血管事件发生的AUC分别为0.903、0.768、0.740,动脉钙化积分显著优于其他(Z=2.917、3.428;P=0.003、<0.001),且动脉钙化积分预测的敏感性为90.16%,显著优于Framingham危险评分及EuroSCOREⅡ评分(均P<0.05)。结论冠状动脉钙化积分对于透析患者心血管事件的发生具有较好预测价值,值得进一步研究与探讨。

Objective To explore the predictive value of coronary calcification score for cardiovascular event risk in dialysis patients.Methods From January 2016 to June 2017,148 patients receiving MHD treatment in our hospital were selected and divided into observation group and control group according to whether cardiovascular events occurred during the observation period(18 months).General data,vital signs,blood biochemical examination,coronary calcification score,Framingham risk score and EuroSCOREⅡscore were compared between the two groups.ROC curves were used to evaluate the predictive efficacy of different models in predicting cardiovascular events.Results Sixty-one cases(41.22%)of cardiovascular events occurred in this study.There were significant differences in total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,high-density troponin,b-type natriuretic peptide and Glomerular Filtration Rate(GFR)between the two groups(all P<0.05).The coronary artery calcification score of observation group was significantly higher than control group(t=7.714,P<0.001).There were significant difference in Framingham risk score and the EuroSCOREⅡscore between the two groups(Z=6.288,5.003;all P<0.001).The AUC of coronary artery calcification score,Framingham risk score and EuroSCOREⅡscore was 0.903,0.768 and 0.740,respectively.The arterial calcification score was significantly better than others(Z=2.917,3.428;P=0.003,<0.001),and the sensitivity of arterial calcification score prediction was 90.16%,which was significantly better than Framingham risk score and EuroSCOREⅡscore(all P<0.05).Conclusion Coronary calcification score is a good predictive value for the occurrence of cardiovascular events in dialysis patients,it is worthy of further study and discussion.