维持性血液透析患者腹主动脉钙化进展的危险因素分析

Risk Factors for Progression of Abdominal Aortic Calcification in Maintenance Hemodialysis Patients

目的:研究维持性血液透析(MHD)患者腹主动脉钙化(AAC)进展的主要因素。方法:纳入2019年03月—2021年03月在本中心接受MHD的203例患者为研究对象。腹部侧位X线片评估腹主动脉钙化积分(AAC score,AACs),随访2年后再次评估患者AACs。根据AACs变化情况分为AAC快速进展组和AAC非快速进展组两组。采用多因素Logistic回归分析方法对腹主动脉钙化进展的危险因素进行分析。结果:MHD患者基线AAC(AACs≥1)发生率为64%(130/203)。观察2年,再次接受AACs评估的患者148例,AAC发生率为77.7%(115/148),其中新发AAC 21例,AAC快速进展组58例,非快速进展组90例。Logistic多因素回归分析结果提示,高钙血症(OR=12.643,P<0.05),超敏C反应蛋白水平高(OR=1.056,P<0.05),血高密度脂蛋白胆固醇水平低(OR=0.100,P<0.05)是腹主动脉钙化进展的独立危险因素。结论:高钙血症、超敏C反应蛋白(hs-CRP)水平高,血高密度脂蛋白胆固醇(HDL)水平低可能加速MHD患者腹主动脉钙化。调整血钙和脂代谢,改善微炎症状态可延缓MHD患者血管钙化的进展。

Objective:To investigate the risk factors for the progression of abdominal aortic calcification(AAC)in maintenance hemodialysis(MHD)patients.Methods:Total of 203 patients MHD between March 2019 and March 2021 in our dialysis center were included.Patients’lateral lumbar radiography were applied to evaluate their abdominal AAC score(AACs)at baseline and after two years of follow-up respectively.According to the changes of AAC scores,patients were divided into AAC rapid progression group and non-rapid progression group.Multivariate logistic regression models were used to analyze the risk factors for the progression of AAC in MHD patients.Results:At baseline,the presence of AAC(AACS≥1)in MHD patients was 64%(130/203).The follow-up duration was 2 years and 148 patients underwent AACs evaluation again.The presence of AAC was 77.7%(115/148).During the two years,21 cases developed new AAC.The AAC rapid progression group was seen in 58 cases and the non-rapid progression group in 90 cases.Multivariate logistic regression analysis demonstrated that hypercalcemia(OR=12.643,P<0.05),high level of high-sensitivity C-reactive protein(OR=1.056,P<0.05)and low level of blood high-density lipoprotein cholesterol(OR=0.100,P<0.05)were independent risk factors for AAC progression.Conclusion:Hypercalcemia,high level of high-sensitivity C-reactive protein and low level of blood HDL cholesterol may accelerate AAC progression in MHD patients.Controlling blood calcium and lipid metabolism,as well as improving micro inflammation,may slow the progression of vascular calcification in MHD patients.