维持性血液透析患者心脏瓣膜钙化相关危险因素分析

Analysis of Risk Factors Related to Heart Valve Calcification in Maintenance Hemodialysis Patients

目的探讨维持性血液透析患者心脏瓣膜钙化情况及其相关危险因素进行分析。方法回顾性分析该院2018年3—11月152例MHD患者,透龄≥3个月。心脏彩超检查先排除风湿性心脏瓣膜病、先天性心脏病及感染性心内膜炎等瓣膜疾病。根据心脏超声检查有无心脏瓣膜钙化将患者分为钙化组和非钙化组,比较两组患者性别、年龄、透龄、体重指数(BMI)、血压、KT/V、吸烟、糖尿病、血色素、血浆白蛋白、血脂、碱性磷酸酶、尿素氮、肌酐、尿酸、钙磷、全段甲状旁腺激素(iPTH)及心脏结构指标、左室心肌质量指数(根据Devereux公式计算)的差异,应用多因素Logistic回归分析法分析心脏瓣膜钙化的相关危险因素。结果钙化组室间隔厚度(IVST)(10.35±1.85)mm明显高于非钙化组(10.04±1.60)mm,差异无统计学意义(t=1.108,P=0.270)。钙化组及非钙化组左房内径(LAD)、左室后壁厚度(PWT)、左室舒张末内径(LVDd)、左室舒张末容积(LVEDV)、左室收缩期容积(LVFS)、左室射血分数(LVEF)、左心室心肌质量指数(LVMI)等指标差异无统计学意义(P>0.05)。结论维持性血液透析患者心脏瓣膜钙化发病率高,其中以主动脉瓣和二尖瓣钙化为主。心脏瓣膜钙化与透析患者年龄、糖尿病病史、血校正钙、甘油三酯均相关,Logistic回归分析显示年龄是心脏瓣膜钙化的独立危险因素。

Objective To investigate the calcification of heart valves and related risk factors in maintenance hemodialysis patients.Methods A retrospective analysis of patients with MHD 152 cases from March 2018 to November 2018 in the hospital,through age≥3 months.Cardiac color Doppler ultrasound examination first ruled out valve diseases such as rheumatic heart valve disease,congenital heart disease,and infective endocarditis.Patients were divided into calcification group and non-calcification group according to the presence or absence of cardiac valve calcification in cardiac ultrasound examination,and the gender,age,penetration age,body mass index(BMI),blood pressure,KT/V,smoking,diabetes,hemoglobin,and plasma were compared between the two groups.Differences in albumin,blood lipids,alkaline phosphatase,urea nitrogen,creatinine,uric acid,calcium and phosphorus,total parathyroid hormone(iPTH),cardiac structure indicators,and left ventricular myocardial mass index(calculated according to the Devereux formula)were widely used Factor Logistic regression analysis method to analyze the related risk factors of heart valve calcification.Results The interventricular septal thickness(IVST)(10.35±1.85)mm in the calcification group was significantly higher than that in the non-calcification group(10.04±1.60)mm,the difference was no statistically significant(t=1.108,P=0.270).Left atrial inner diameter(LAD),left ventricular posterior wall thickness(PWT),left ventricular end diastolic inner diameter(LVDd),left ventricular end diastolic volume(LVEDV),left ventricular end diastolic volume(LVEDV),left ventricular systolic volume(LVFS),left ventricular Ventricular ejection fraction(LVEF),left ventricular myocardial mass index(LVMI)and other indicators showed no statistically significant difference(P>0.05).Conclusion The incidence of heart valve calcification is high in maintenance hemodialysis patients,and the aortic valve and mitral valve calcification are the main ones.Heart valve calcification is related to dialysis patients’age,diabetes history,blood corrected calcium,and triglycerides.Logistic regression analysis shows that age is an independent risk factor for heart valve calcification.