CT冠状动脉钙化评分与慢性肾脏病患者心血管事件风险的相关性

Correlation between coronary artery calcification score on CT and risk of cardiovascular events in patients with chronic kidney disease

目的探讨CT冠状动脉钙化评分(CAS)与慢性肾脏病(CKD)患者心血管事件(CVD)发生的相关性,分析CKD患者发生CVD的危险因素。方法选择2016年4月至2017年12月于我院就诊的有心血管疾病危险因素的CKD患者167例,所有患者均通过螺旋CT进行CAS评分评估,并进行相关血液指标检测,患者根据自身情况进行相应的药物治疗,并进行为期1年的随访,统计所有患者随访期间CVD发生率以及预后情况,而后根据患者随访期间CVD的发生情况将所有患者分为无CVD组和CVD组,分析CAS评分与CVD发生率之间的关系,以及各组间不同风险人数之间的差异,并分析导致CVD发生的危险因素。结果整个随访过程中共计56例发生CVD,发生率为33.53%;无CVD组患者冠状动脉4个分支CAS评分以及总分均显著低于CVD组(P<0.05);CVD组患CAS评分中度风险例数显著高于无CVD组,而CAS极低风险例数显著低于无CVD组(P<0.05);无CVD组患者平均年龄显著低于CVD组,糖尿病和高血压例数显著高于CVD组(P<0.05);无CVD组患者甲状旁腺素(iPTH)、高敏感T蛋白(hs-cTnT)、N末端B型利钠抗原(NT-proBNP)低于CVD组(P<0.05);Logistics回归分析结果显示:年龄、肾小球滤过率eGFR以及CAS总分是CKD患者发生CVD的独立危险因素(P<0.05)。结论CAS是CKD患者CVD发生的独立危险因素,且CAS与CVD发病率呈正相关,可以作为CKD患者开展CVD预防治疗的指标。

Objective To investigate the correlation between coronary artery calcification score(CACS)on CT and cardiovascular events(CVE)in patients with chronic kidney disease(CKD),and to identify the risk factors of CVE in CKD patients.Methods Included in this study were 167 CKD patients who presented risk factors of cardiovascular disease when admitted to our hospital between April 2016 and December 2017.All patients underwent CACS by spiral CT,and examined for relevant blood biochemical indicators.The patients were treated according to their specific conditions and followed up for 1 year.The incidence of CVE and prognosis during follow-up were recorded.All patients were divided into the non-CVE group and CVE group according to the occurrence of CVE during the follow-up.The relationship between CACS and the incidence of CVE was investigated.The difference in number of patients at risk between the two groups and the risk factors leading to CVE were analyzed.Results A total of 56 patients developed CVE during the follow-up period,with an incidence of 33.53%.The individual CACS of the four coronary artery branches and the total CACS were significantly lower in the non-CVE group than those in the CVE group(P<0.05).There wer more patients with moderate risk and fewer with very low risk by CACS assessment in the CVE group than those in the non-CVE group(P<0.05).The non-CVE group presented younger mean age,more patients with diabetics and hypertension patients,compared with the CVE group(P<0.05).The iPTH,hs-cTnT,NT-proBNP and eGFR were significantly lower in the non-CVE group than those in the CVE group(P<0.05).Logistics regression showed that age,eGFR and CACS were independent risk factors for CVE in CKD patients(P<0.05).Conclusion CACS is an independent risk factor for CVE in CKD patients.Given the positive correlation between CACS and occurrence of CVE,CACS can be used as a predictor of CVE in CKD patients.