CKD3~5期维持性血液透析患者腹主动脉钙化的发生及其进展相关因素

Occurrence of abdominal aortic calcification and related factors of its progress in CKD patients at stage 3-5 undergoing maintenance hemodialysis

目的:探讨慢性肾脏病(chronic kidney disease,CKD)3~5期维持性血液透析患者腹主动脉钙化(abdominal aortic calcification,AAC)发生及进展情况,分析其影响因素。方法:选取2017年1月至2018年3月阜阳市第二人民医院80例CKD3~5期维持性血液透析患者,分析影响患者AAC发生及进展的危险因素。结果:80例CKD3~5期维持性血液透析患者中包括无钙化者44例,钙化者36例;Logistic回归分析结果显示,年龄、高血压病史、糖尿病病史、冠心病史、C反应蛋白、血磷、三酰甘油、全段甲状旁腺激素是CKD3~5期维持性血液透析患者AAC发生的独立危险因素,25羟维生素D是影响AAC的保护因素;随访2年,共有67例患者复查腹部侧位X线片完成随访,其中AAC进展组32例(新发14例),非AAC进展组35例;Logistic回归分析结果显示,年龄、血磷、C反应蛋白、三酰甘油、全段甲状旁腺激素是CKD3~5期维持性血液透析患者AAC进展的独立危险因素,25羟维生素D、高密度脂蛋白是影响AAC进展的保护因素。结论:年龄、高血磷、高血压病史、糖尿病病史、冠心病史、高水平C反应蛋白、低水平25羟维生素D、高三酰甘油、高全段甲状旁腺激素是血液透析患者AAC发生的独立危险因素,高水平血磷及低水平25羟维生素D、高三酰甘油、高全段甲状旁腺激素、高密度脂蛋白胆固醇是血液透析患者AAC进展的独立危险因素。

Objective:To explore the occurrence and progress of abdominal aortic calcification(AAC)in patients with chronic kidney disease(CKD)at stage 3-5 undergoing maintenance hemodialysis,and analyze its influencing factors.Methods:A total of 80 CKD patients at stage 3-5 who underwent maintenance hemodialysis in Fuyang Second People’s Hospital from January 2017 to March 2018 were enrolled.The risk factors that affected the occurrence and progress of AAC were analyzed.Results:Among the 80 CKD patients at stage 3-5 undergoing maintenance hemodialysis,there were 44 cases without calcification and 36 cases with calcification.The results of Logistic regression analysis showed that age,histories of hypertension,diabetes,coronary heart disease,C-reactive protein,serum phosphorus,triacylglycerol and intact parathyroid hormone were independent risk factors of AAC occurrence,while 25-hydroxyvitamin D was a protective factor.They were followed up for 2 years and 67 patients were followed up with X-rays reexamination at the abdominal lateral side,including 32 cases(14 new onset cases)in AAC progress group and 35 cases in non-AAC progress group.The results of Logistic regression analysis showed that age,serum phosphorus,C-reactive protein,triacylglycerol and intact parathyroid hormone were independent risk factors of AAC progress,while 25-hydroxyvitamin D and high-density lipoprotein were protective factors.Conclusion:Age,serum phosphorus,histories of hypertension,diabetes,coronary heart disease,high level of C-reactive protein,low levels of 25-hydroxyvitamin D,triacylglycerol and intact parathyroid hormone affect the occurrence of AAC in hemodialysis patients,independently while high-level serum phosphorus,low-level 25-hydroxyvitamin D,high-level triacylglycerol,high-level intact parathyroid hormone and low-level high-density lipoprotein cholesterol affect the progress of AAC independently.