围透析期慢性肾脏病患者血管钙化与炎症、低蛋白血症的相关性研究

Correlation of vascular calcification with inflammation and hypoproteinemia in peridialysis patients

目的 探讨围透析期慢性肾脏病患者低蛋白血症、炎症和冠状动脉钙化及进展的关系。方法 纳入2019年3月至2021年6月在贵阳市第一人民医院肾内科门诊和血液透析(血透)中心就诊的97例围透析期慢性肾脏病患者,记录患者基线资料,包括性别、年龄、原发和继发的肾脏疾病、合并症、体重指数、降压药物、降脂药物、磷结合剂、维生素D受体激动剂使用情况、入组时的冠状动脉钙化积分和随诊12个月后冠状动脉钙化积分;非血透患者空腹采血,血透患者在透析前空腹采血,检测钙、磷、血清白蛋白、胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白、超敏C-反应蛋白等,放射免疫法检测全段甲状旁腺激素,观察不同组别间患者临床资料及实验室结果,通过单因素和多因素logistic回归法分析冠状动脉钙化进展的危险因素。结果 97例患者中53例在12个月后出现冠状动脉钙化进展,与冠状动脉钙化无进展组相比,进展组患者年龄较大,男性占比高,心脑血管并发症发生率高,超敏C-反应蛋白和全段甲状旁腺激素水平更高,血清白蛋白水平更低,胆固醇和低密度脂蛋白胆固醇水平更低,从使用药物的情况来看,冠状动脉钙化进展组患者使用他汀类药物和磷结合剂比例更高,差异均有统计学意义(P<0.05);与基线没有低蛋白血症和炎症状态的患者相比,基线有低蛋白血症和(或)炎症状态的患者年龄更大、合并糖尿病比例更高、体重指数更高、高密度脂蛋白和血磷水平更低,而12个月后冠状动脉钙化进展的比例更高,差异均有统计学意义(P<0.05)。多元回归分析提示低白蛋白血症、超敏C-反应蛋白、基线时存在冠状动脉钙化和低密度脂蛋白是冠状动脉钙化进展的显著独立危险因素(P<0.05)。结论 围透析期慢性肾脏病患者中超过半数患者合并炎症和(或)低蛋白血症,而炎症和低蛋白血症与冠状动脉钙化和冠状动脉钙化进展显著相关。

Objective To investigate the relationship between hypoalbuminemia,inflammation and coronary artery calcification and its progression in peridialysis patients.Methods A total of 97 patients with chronic kidney disease in the peridialysis period who attended the outpatient clinic and hemodialysis center of Guiyang First People′s Hospital nephrology department from March 2019 to June 2021 were included.The baseline data of the patients were recorded,including gender,age,primary and secondary renal diseases,complications,body mass index,use of antihypertensive drugs,lipid-lowering drugs,phosphorus binders,vitamin D receptor agonists,coronary artery calcification score at enrollment and after 12 months of follow-up.Non-hemodialysis patients took blood on an empty stomach,hemodialysis patients took blood on an empty stomach before dialysis.Calcium,phosphorus,serum albumin,cholesterol,triglyceride,low-density lipoprotein,high-density lipoprotein,high sensitivity C-reactive protein were detected.The whole parathyroid hormone was detected by radioimmunoassay,the clinical data of patients in different groups were observed,and the risk factors of coronary artery calcification progression were analyzed by univariate and multifactorial logistic regression.Results Among the 97 patients,a total of 53 patients developed coronary artery calcification after 12 months.Compared with the group without coronary artery calcification progression,patients in the group with coronary artery calcification progression were older,had a higher proportion of males,a higher incidence of cardiovascular and cerebrovascular complications,higher levels of high sensitivity C-reactive protein and parathyroid hormonei,lower levels of serum albumin,lower levels of cholesterol and low-density lipoprotein.From the perspective of drug use,patients in the group with coronary artery calcification progression used statins and phosphorus binders more frequently,all differences were statistically significant(P<0.05).Compared with the patients without hypoproteinemia and inflammatory status at baseline,the patients with hypoproteinemia and/or inflammatory status at baseline were older,had a higher proportion of diabetes,higher body mass index,lower high density lipoprotein,and higher proportion of coronary artery calcification progression after 12 months,all differences were statistically significant(P<0.05).Multiple regression analysis showed that hypoproteinemia,high sensitivity C-reactive protein,the presence of coronary artery calcification at baseline and the level of low density lipoprotein were significant independent risk factors for the progression of coronary artery calcification.Conclusion More than half of the patients in the peridialysis period were associated with inflammation and/or malnutrition,and inflammation and malnutrition were significantly associated with coronary artery calcification and coronary artery calcification progression.