维持性血液透析患者心脏瓣膜钙化对病死率的影响分析

Impact of cardiac valve calcification on mortality in patients undergoing maintenance hemodialysis

目的通过研究本中心接受血液透析的患者在近3年中的临床情况和检查、实验室结果,分析其对病死率的影响,尤其是心脏瓣膜钙化对维持性血液透析患者病死率的影响。方法分析在我院接受血液透析至少6个月的患者443例。对死亡和存活患者的首次记录数据和临床发现进行了比较。结果298例患者存活,145例患者死亡。死亡患者的平均年龄较高,60%患者有冠心病,53.8%患者有心脏瓣膜钙化。死亡患者血液透析持续时间较低。碱性磷酸酶、白蛋白,尿素清除指数(Kt/V)在死亡患者中水平更低,C反应蛋白、全段甲状旁腺激素、透析前血钾水平在死亡患者中较高。Logistic回归分析显示年龄、冠状动脉疾病和多个心脏瓣膜钙化(两个及以上心脏瓣膜钙化)是病死率的独立危险因素。透析前钾水平、全段甲状旁腺激素和较高的尿素清除指数(Kt/V)对生存率有利。结论年龄、冠状动脉疾病、多个心脏瓣膜钙化是维持性血液透析患者死亡的危险因素。

Objective To analyze the impact of clinical condition,examination and laboratory results,especially cardiac valve calcification,on mortality of patients undergoing maintenance hemodialysis in our center in the past three years.Methods A total of 443 patients undergoing hemodialysis in our hospital were analyzed.The first recorded data and clinical findings of dead and alive patients were compared.Results Among all patients,298 patients survived and 145 died.Dead patients had an older mean age,60%of dead patients had coronary heart disease,and 53.8%had cardiac valve calcification.The duration of hemodialysis was shorter in dead patients.Alkaline phosphatase,albumin,urea clearance index(Kt/V)were lower,while C-reactive protein,full-length parathyroid hormone and the potassium level before hemodialysis were higher in dead patients.Logistic regression analysis showed that age,coronary artery disease(CAD)and multiple cardiac valve calcification(≥2)were independent risk factors for mortality.Potassium level before hemodialysis,full-length parathyroid hormone and higher Kt/V were conductive to survival.Conclusion Age,CAD and multiple cardiac valve calcification are risk factors for mortality of patients undergoing maintenance hemodialysis.