终末期肾病患者心脏瓣膜钙化与左心室功能的关系

Cardiac valve calcification in patients with end stage renal disease and its correlation with left ventricular function

目的心血管系统钙化在终末期肾病患者中具有较高的发生率。文中应用超声心动图评估终末期肾病患者心脏瓣膜钙化情况,探讨心脏瓣膜钙化与左心室功能、形态的关系。方法回顾性分析2013年6月至2013年8月于东部战区总医院行血液透析治疗的137例终末期肾病患者超声心动图检查结果,评估心脏瓣膜钙化情况,测量左心室形态结构及功能参数。通过Logistic回归分析探讨心脏瓣膜钙化发生的独立危险因素。结果本组终末期肾病患者中,55例患者存在心脏瓣膜钙化,心脏瓣膜钙化患者年龄[(52.7±11.1)岁]、低密度脂蛋白[(2.7±0.8)mg/dL]及总胆固醇水平[(5.2±1.1)mg/dL]均高于无瓣膜钙化患者[(42.6±12.3)岁、(2.2±0.6)mg/dL、(4.5±0.9)mg/dL],肌酐水平低于无瓣膜钙化患者[(10.7±2.7)mg/dL vs(13.2±8.5)mg/dL],差异均有统计学意义(P<0.05)。Logistic回归分析显示,高龄(OR=1.081)、长时间透析(OR=1.102)及高二尖瓣瓣环收缩期运动速度(OR=3.112)为心脏瓣膜钙化发生的独立危险因素。左心室形态结构参数均高于无瓣膜钙化组(P<0.05);左心室舒张功能参数均低于无瓣膜钙化组,差异有统计学差异(P<0.05)。结论终末期肾病患者存在心脏瓣膜钙化时,左心室肥大、左心室舒张功能减低的发生率均明显增加。

Objective Cardiovascular calcification is a highly common complication in patients with end stage renal disease.The aim of this study was to explore the effect of cardiac valve calcification(VC)on left ventricular function and morphology in patients with end stage renal disease by echocardiography.Methods Echocardiography results of 137 patients with end stage renal disease who underwent hemodialysis in the general hospital of the eastern theater of war from June 2013 to August 2013 were retrospectively analyzed.The morphological structure and function parameters of the left ventricle were measured by echocardiography and tissue doppler imaging to assess cardiovascular calcification.Logistic regression analysis was used to investigate the independent risk factors of cardiac valve calcification.Results VC was found in 55 patients(40.1%)in this study.The age[(52.7±11.1)vs(42.6±12.3)],low density lipoprotein[(2.7±0.8)mg/dL vs(2.2±0.6)mg/dL],cholesterol[(5.2±1.1)mg/dL vs(4.5±0.9)mg/dL]levels were higher,while serum creatinine[(10.7±2.7)mg/dL vs(13.2±8.5)mg/dL]was lower in patients with VC than patients without VC(P<0.05).Logistic regression analysis showed that the older age,longer dialysis time and higher mean value of mitral annular systolic values were the independent risk factors for VC.The morphological and structural parameters of the left ventricle of the group with VC were higher than those of the group without VC(P<0.05),while the parameters of left ventricular diastolic function of the group with VC were lower than those of the group without VC(P<0.05).Conclusion VC diagnosed by echocardiography in patients with end stage renal disease may indicate significantly higher incidence of left ventricular hypertrophy and reduction of left ventricular diastolic function in comparison to those without VC.