慢性肾脏病腹膜透析患者尿白蛋白水平与冠状动脉钙化的相关性

The correlation between urinary albumin level and coronary artery calcification in patients with chronic kidney disease undergoing peritoneal dialysis

目的:探究慢性肾脏病(CKD)腹膜透析(PD)患者尿白蛋白(UAlb)水平与冠状动脉钙化(CAC)的相关性。[方法]选择2020年2月—2022年6月于咸阳市中心医院住院行PD治疗的186例CKD患者为研究对象,纳入训练集;根据Rumberger CAC程度分级法分为无钙化组(0~10分,80例)和钙化组(>10分,106例);按照相同标准另选择2022年7月—11月于咸阳市中心医院住院行PD治疗的62例CKD患者,纳入验证集。对比分析两组患者的临床资料;通过曲线拟合及阈值效应分析确定UAlb的阈值效应;采用多因素Logistic回归分析影响CAC发生的危险因素;构建列线图预测模型,并进行模型评价。[结果]当UAlb>30 mg/L时,随着其水平的升高,CAC的发生风险呈上升趋势。年龄>50岁、透析时间>20个月、糖尿病、中性粒细胞与淋巴细胞比值(NLR)≥3.5、血磷≥1.8 mmol/L、UAlb>30 mg/L均是CAC发生的独立危险因素(P<0.05)。列线图预测模型评价结果显示,列线图预测模型的区分度、准确度及有效性均较高。[结论]当UAlb>30 mg/L时,随着其水平升高,CAC的发生风险呈上升趋势。年龄>50岁、透析时间>20个月、糖尿病、NLR≥3.5、血磷≥1.8 mmol/L、UAlb>30 mg/L均是CAC发生的独立危险因素。

Aim To investigate the correlation between urinary albumin(UAlb)level and coronary artery calcification(CAC)in patients with chronic kidney disease(CKD)undergoing peritoneal dialysis(PD).Methods 186 CKD patients hospitalized in Xianyang Central Hospital for PD treatment from February 2020 to June 2022 were selected as research objects and included in the training set;according to Rumberger CAC grading method,they were divided into non-calcification group(0~10 points,80 cases)and calcification group(>10 points,106 cases);according to the same criteria,62 CKD patients hospitalized in Xianyang Central Hospital for PD treatment from July 2022 to November 2022 were included in the validation set.The clinical data of the two groups were compared and analyzed.The threshold effect of UAlb was determined by curve fitting and threshold effect analysis.Multivariate Logistic regression was used to analyze the risk factors affecting the occurrence of CAC,and an nomogram prediction model was constructed and evaluated.Results When UAlb>30 mg/L,the risk of CAC increased with the increase of its level.Age>50 years old,dialysis time>20 months,diabetes,neutrophil-to-lymphocyte ratio(NLR)≥3.5,phosphorus≥1.8 mmol/L,and UAlb>30 mg/L were independent risk factors for CAC(P<0.05).The evaluation results showed that the discrimination,accuracy and effectiveness of the nomograph prediction model were high.Conclusions When UAlb>30 mg/L,the risk of CAC increases with its level.Age>50 years old,dialysis time>20 months,diabetes,NLR≥3.5,phosphorus≥1.8 mmol/L,UAlb>30 mg/L are all independent risk factors for CAC.