珠三角地区血液透析患者代谢性酸中毒与心脏瓣膜钙化的相关关系——多中心横断面研究

Correlation analysis between metabolic acidosis and cardiac valve calcification in hemodialysis patients in the Pearl River Delta Region—a multicenter cross-sectional study

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者代谢性酸中毒与心脏瓣膜钙化的相关关系。方法选择2019年7月1日至9月30日在珠三角地区10家血液净化中心行MHD大于3个月的患者纳入该多中心横断面研究,应用心脏彩超检查分为非心脏瓣膜钙化组和心脏瓣膜钙化组,记录人口学特征、透析次数、血压、单室尿素清除指数(spKt/V)以及透析用药,透析前留取血清完善实验室检查,比较两组间各指标的差异。采用Spearman相关分析分析血清CO2结合力(CO2CP)与心脏瓣膜钙化的相关关系,采用多因素Logistic回归模型分析心脏瓣膜钙化的影响因素。结果共664例MHD患者被纳入本研究,男性395例(59.5%),女性269例(40.5%);年龄(57.0±14.2)岁,透析龄43.0(22.3,71.7)个月,合并糖尿病119例(17.9%),每周透析2次患者有186例(28.0%);心脏瓣膜钙化组329例(49.5%),非心脏瓣膜钙化组335例(50.5%)。与非心脏瓣膜钙化组相比,心脏瓣膜钙化组透析龄更长(P<0.05),舒张压、空腹血糖、全段甲状旁腺素、铁蛋白水平更高(均P<0.05),每周透析2次患者比例、血CO2CP<19 mmol/L(CO2CP中位数为19 mmol/L)患者比例以及钙离子拮抗剂类、血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂类、β受体阻滞剂、α受体阻滞剂、骨化三醇、碳酸镧使用比例更高(均P<0.05),而spKt/V、血红蛋白、血清CO2CP、校正钙、血磷、血碱性磷酸酶、白蛋白、总胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白、转铁蛋白饱和度水平较低(均P<0.05),司维拉姆、西那卡塞使用比例也较低(均P<0.05)。Spearman相关分析结果提示血清CO2CP与心脏瓣膜钙化呈负相关(rs=-0.697,P<0.001)。多因素Logistic回归分析结果显示,每周透析2次(OR=2.789,95%CI 1.232~6.305,P=0.014)、血总胆固醇(OR=1.449,95%CI 1.014~2.071,P=0.042)、CO2CP<19 mmol/L(OR=22.412,95%CI 10.640~47.210,P<0.001)是MHD患者发生心脏瓣膜钙化的影响因素。结论MHD心脏瓣膜钙化患者存在明显的酸负荷,代谢性酸中毒是心脏瓣膜钙化的独立影响因素。

Objective To explore the relationship between metabolic acidosis and cardiac valve calcification in maintenance hemodialysis(MHD)patients in the Pearl River Delta Region.Methods Patients on MHD greater than 3 months who were treated in 10 blood purification centers in the Pearl River Delta Region from July 1 to September 30,2019 were selected for this multicenter cross-sectional study.Based on a Doppler ultrasound,MHD patients were further divided into non-valve calcification group and valve calcification group.The demographics data,frequency of dialysis,blood pressure,single pool Kt/V(spKt/V),dialysis medications and laboratory data were collected and compared.Spearman correlation analysis was used to analyze the correlation between serum carbon dioxide combining power(CO2CP)and cardiac valve calcification.Multivariate logistic regression model was used to analyze the influencing factors of cardiac valve calcification.Results A total of 664 MHD patients were included in this study,with age of(57.0±14.2)years old and dialysis age of 43.0(22.3,71.7)months,including 395 males(59.5%)and 269 females(40.5%).Among them,there were 119 patients(17.9%)with diabetes and 186 patients(28.0%)with dialysis 2 times per week.There were 329 patients(49.5%)in the valve calcification group,and 335 patients(50.5%)in the non-valve calcification group.Compared to those in non-valve calcification group,valve calcification group had longer duration of dialysis,higher proportion of patients with dialysis 2 times per week,higher levels of diastolic blood pressure,fasting blood glucose,intact parathyroid hormone and ferritin,higher proportion of patients with blood CO2CP<19 mmol/L(median CO2CP),higher proportion of patients on usage of calcium channel blocker,angiotensin converting enzyme inhibitor/angiotensin receptor blocker,α-receptor blocker,β-receptor blocker,calcitriol and lanthanum carbonate(all P<0.05),while the levels of spKt/V,hemoglobin,serum CO2CP,corrected calcium,blood phosphorus,blood alkaline phosphatase,albumin,total cholesterol,triacylglycerol,low-density lipoprotein,high-density lipoprotein,transferrin saturation,and the proportion of patients on usage of sevelamer and cinacalcet were lower(all P<0.05).Spearman analysis showed significant negative correlation between serum CO2CP and valve calcification(rs=-0.697,P<0.001).Multivariate logistic regression analysis showed that dialysis performed twice a week(OR=2.789,95%CI 1.232-6.305,P=0.014),blood total cholesterol(OR=1.449,95%CI 1.014-2.071,P=0.042),CO2CP<19 mmol/L(OR=22.412,95%CI 10.640-47.210,P<0.001)were the influencing factor of valve calcification in MHD patients.Conclusions MHD patients with cardiac valve calcification have significant acid loading.Metabolic acidosis is an independent influencing factor for cardiac valve calcification in MHD patients.