维持性血液透析患者甲状腺激素水平与腹主动脉钙化的相关性分析

Correlation between thyroid hormone levels and abdominal aortic calcification in maintenance hemodialysis patients

目的分析维持性血液透析(maintenance hemodialysis,MHD)患者甲状腺激素水平与腹主动脉钙化的关系,同时分析影响腹主动脉钙化的其他相关指标,为早期防治MHD患者血管钙化提供一定的临床依据。方法选取2019年1—12月在徐州医科大学附属医院血液透析中心治疗的MHD患者78例,透析时间≥3个月。收集患者的一般临床资料、生化指标,并测定游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)。用腹部侧位X线平片检查患者腹主动脉钙化的情况,根据是否发生血管钙化将患者分为非钙化组(42例)和钙化组(36例),比较2组间临床资料的差异,分析MHD患者甲状腺激素水平及其他相关指标与腹主动脉钙化的关系。结果78例MHD患者中36例(46.15%)发生腹主动脉钙化。钙化组年龄低密度脂蛋白(LDL-C)、血磷(P)、C反应蛋白(CRP)、钙磷乘积均明显高于非钙化组,白蛋白、FT3均明显低于非钙化组,差异均有统计学意义(均P<0.05)。相关性分析显示FT3与CRP、LDL-C呈负相关(均P<0.05)。多因素logistic回归分析显示,CRP升高、P升高、FT3降低是腹主动脉钙化的独立危险因素。CRP、P、FT3对应的ROC曲线下面积分别为0.804、0.704、0.746。结论MHD患者腹主动脉钙化发生率高,CRP水平升高、P水平升高、FT3水平降低与腹主动脉钙化密切相关。FT3的检测对预测MHD患者的腹主动脉钙化具有一定价值。

Objective To analyze the relationship between thyroid hormone levels and abdominal aortic calcification in maintenance hemodialysis(MHD)patients,and to analysis the clinical indicators which related to vascular calcification,and to provide a clinical basis for early prevention and treatment of vascular calcification.Methods Data of a 78 MHD patients treated in the Hemodialysis Center of Affiliated Hospital of Xuzhou Medical University from January 2019 to De-cember 2019 were collected,and the dialysis age was≥3 months.The clinical data and biochemical indicators of patients were collected,and free triiodothyronine(FT3),free thyroxine(FT4),and thyroid stimulating hormone(TSH)were measured.Patients were examined for abdominal aortic calcification with plain lateral X-ray films,and the patients were divided into non-calcified group and calcified group according to whether vascular calcification occurred.The clinical data between the two groups were compared,and the relationship between thyroid hormone levels and abdominal aortic calcifi-cation in MHD patients was analyzed.Results Among 78 MHD patients,36 had abdominal aortic calcification with an incidence of 46.15%.The calcification group had significantly higher low-density lipoprotein(LDL-C),blood phosphor-us(P),C-reactive protein(CRP),and calcium-phosphorus products.In the non-calcified group,albumin and FT3 were significantly lower than those in the calcified group,and the differences were statistically significant(all P<0.05).Correlation analysis between FT3 and various indicators showed that FT3 was negatively correlated with CRP,LDL-C(all P<0.05).Multivariate logistic regression analysis of related risk factors showed that elevated CRP,elevated P,and de-creased FT3 were independent risk factors of abdominal aortic calcification.The area under the ROC curve of CRP,P,FT3 were 0.804,0.704 and 0.746 respectively.Conclusion The incidence of abdominal aortic calcification in MHD patients is high.The increase of CRP,P level and the decrease of FT3 level are closely related to abdominal aortic calci-fication.FT3 has certain value in predicting abdominal aortic calcification in patients with MHD.