血液透析患者腹主动脉钙化与左室重量指数及几何构型的关系

Association of Abdominal Aortic Calcification by a Plain X-Ray with Left Ventricular Mass and Geometry in Hemodialysis Patients

目的评价基于平片的腹主动脉钙化积分与血液透析患者左室重量指数和左室重塑的关系。方法选取2016年1月1日-2016年3月31日期间在某院中心透析室行维持性血液透析治疗的186例患者为研究对象。超声心动图评估患者左室重量指数及左室几何构型;腰椎侧位片评估腹主动脉钙化程度。根据钙化积分的中位数将患者分为两组行组间比较。多元逐步回归分析腹主动脉钙化对超声心动图参数的预测价值。结果54.8%的患者为男性;平均年龄58.8±11.6岁;透析龄75.5(36.8~130)月。其中26例(14%)患者存在糖尿病;160例(86%)患者存在不同程度的腹主动脉钙化。总体钙化积分为5.0(1.0~10.25)。钙化积分≤5分者101例;>5分者85例。高钙化积分组左室重量指数更大(50.32±11.74 vs.46.36±11.26 g/m2.7,P=0.020),左室离心性肥厚的罹患率趋向于更高(43/85比39/101,P=0.101)。多元逐步回归分析显示透后收缩压、腹主动脉钙化和体重指数是左室重量指数的独立预测因素。结论血液透析患者经常合并腹主动脉钙化,基于平片的腹主动脉钙化积分是左室重量指数的独立危险因素;钙化积分高者更可能合并左室离心性肥厚。

Objective To evaluate the predictive values for left ventricular mass index and remodeling of abdominal aortic calcification on a plain X-ray in hemodialysis patients.Methods One hundred and eighty-six hemodialysis patients were enrolled.The echocardiogram and left lateral lumbar spine radiograph were performed.According to abdominal aortic calcification score median,patients were divided into two groups.The echocardiographic parameters were compared.The predictive values of abdominal aortic calcification was analyzed by a multiple stepwise linear regression model.Results The participants were predominantly male(54.8%) with an average age of 58.8±11.6 years.Previous hemodialysis durations were 75.5(36.8~130) months.Twenty-six(14%) patients had diabetes mellitus.One hundred and sixty patients(86%) had abdominal aortic calcification.The overall calcification scores were 5.0(1.0~10.25).The abdominal aortic calcification scores of 101 patients were equal or less than 5(n=101),and others were more than 5(n=85).The left ventricular mass indexs were significantly larger in patients with higher calcification scores(50.32±11.74 vs.46.36±11.26 g/m2.7 P=0.020).The prevelance of eccentric left ventricular hypertrophy tended to higher in patients with higher abdominal aortic calcification scores(43/85 vs.39/101,P=0.101).Multiple stepwise linear regression showed that post-dialytic systolic blood pressure,abdominal aortic calcification,and body mass index were the independent predictors of left ventricular mass indexs.Conclusion The present study showed that abdominal aortic calcification C scores by a plain X-ray was an independently predictive factor of left ventricular mass indexs in hemodialysis patients.The prevelance of eccentric left ventricular hypertrophy tended to higher in patients with higher abdominal aortic calcification scores.