心脏瓣膜钙化和颈动脉粥样硬化对维持性腹膜透析患者预后的影响

Association of cardiac valve calcification and carotid atherosclerosis on prognosis in maintenance peritoneal dialysis patients

目的分析心脏瓣膜钙化(cardiac valve calcification,CVC)和颈动脉粥样硬化(carotid athero-sclerosis,CAS)对维持性腹膜透析患者预后的影响,并探讨联合2个指标预测腹膜透析患者全因死亡和心血管死亡的价值。方法2015年7-12月在南京医科大学附属无锡人民医院腹膜透析中心行持续性非卧床腹膜透析(CAPD)或日间非卧床腹膜透析(DAPD)治疗≥3个月的腹膜透析患者,收集患者一般临床资料、实验室检查结果,并行心脏超声和颈动脉超声检查。将CVC、CAS均作为危险标记,将患者分为3组:0、1、2个危险标记组。随访所有患者至死亡、退出腹膜透析或至研究终止(2020年6月30日)。通过Kaplan-Meier法分析3组患者全因死亡和心血管死亡。Cox比例风险模型分析0、1和2个危险标记对患者全因死亡和心血管死亡的预测作用。结果入选166例腹膜透析患者,46(27.7%)例存在CVC,88(53.0%)例存在CAS。70例患者无危险标记,58例存在1个危险标记(CVC或CAS),38例存在2个危险标记(CVC和CAS)。至研究终止,34例患者死亡,其中21例死于心血管疾病。Kaplan-Meier生存分析提示3组间全因死亡及心血管死亡差异具有统计学意义(P<0.001)。Cox回归分析显示与无危险标记的患者相比,2和1个危险标记的患者的全因死亡HR分别为8.011(95%CI:2.493~25.741,P=0.001)和2.711(95%CI:0.820~8.961,P=0.102),心血管死亡的HR分别为6.734(95%CI:1.643~27.610,P=0.008)和1.694(95%CI:0.385~7.460,P=0.486)。与任何1个危险标记相比,联合使用2个危险标记预测全因死亡和心血管死亡的受试者曲线下面积(AUC)均增大。结论CVC和CAS是影响腹膜透析患者危险因素,联合2个指标可更好地预测腹透患者的预后。

Objective To analyze the association of cardiac valve calcification(CVC)and carotid atherosclerosis(CAS)on the prognosis in maintenance peritoneal dialysis patients,and to investigate the value of combining CVC and CAS on all-cause and cardiovascular mortality in PD patients.Methods Patients underwent regular PD duration of≥3 months in PD center of Wuxi people′s hospital affiliated to Nanjing Medical University from July 2015 to December 2015 were enrolled in this study.Their clinical and laboratory information was gathered,cardiac echocardiography and carotid artery color Doppler ultrasound examination were performed in the patients.CVC and CAS are considered as risk markers,The patients were assigned to three groups based on their risk markers(0,1,and 2).All patients were followed up until death,PD discontinuation,or study termination(June 30,2020).The Kaplan-Meier method was used to analyze all-cause and cardiovascular mortality.The Cox proportional hazard model was used to analyze the prediction of all-cause mortality and cardiovascular mortality by risk markers 0,1,and 2.Results A total of 166 patients with PD were enrolled,46(27.7%)patients were with CVC and 88(53.0%)patients were with CAS,70(42.2%)patients had no risk markers,58(34.9%)patients had 1 risk marker(CVC or CAS),and 38(22.9%)patients had 2 risk markers(CVC and CAS).By the end of the study,34 patients had died,and 21 patients were due to cardiovascular events.According to the Kaplan-Meier,there were statistically significant differences in all-cause and cardiovascular mortality between the three groups(P<0.001).The Cox regression analysis revealed that the HR for all-cause mortality in PD patients with 2 and 1 risk markers were 8.011(95%CI:2.493~25.741,P=0.001)and 2.711(95%CI:0.820~8.961,P=0.102),and the HR for cardiovascular mortality was 6.734(95%CI:1.643~27.610,P=0.008)and 1.694(95%CI:0.385~7.460,P=0.486),compared with those without risk markers.When combined with both risk markers,the area under the curve(AUC)of all-cause and cardiovascular mortality increased when compared to any single risk marker.Conclusion CVC and CAS are risk markers for PD patients,and the combination of these two markers can better predict PD patient prognosis.