慢性肾病患者低镁血症与动脉粥样硬化发生的相关性分析

Correlation analysis of hypomagnesemia and atherosclerosis in patients with chronic kidney disease

目的探讨慢性肾病(CKD)患者低镁血症与动脉粥样硬化(AS)发生的相关性。方法选择2017年1月至2020年1月期间于新疆军区总医院北京路医疗区肾脏内科住院的CKD 5期患者402例,根据颈动脉超声检查结果,将患者分为AS组140例和非AS组262例,比较两组临床检查指标,血清镁、超敏C反应蛋白(hs-CRP)、颈动脉内中膜厚度(IMT)和肾小球滤过率估算值(eGFR)水平。多因素Logistic回归分析CKD患者并发AS的独立危险因素,分析血清镁与hs-CRP、IMT和eGFR的相关性。采用ROC曲线分析低镁血症对CKD患者发生AS的预测价值。结果AS组有高血压史的患者比例更高,且低密度脂蛋白胆固醇(LDL-C)、hs-CRP、尿酸(UA)水平和IMT均显著高于非AS组,而血清镁和eGFR水平低于非AS组(t/χ^(2)=4.109、3.584、10.877、2.459、26.035、5.652、7.040,P<0.05)。血清镁、hs-CRP、IMT和eGFR均为CKD患者合并AS的影响因素[OR(95%CI)=3.221(2.635~5.548)、6.582(4.235~7.634)、8.917(6.344~9.213)、3.165(2.251~5.337),P<0.05]。血清镁预测CKD患者发生AS的曲线下面积为0.784(95%CI=0.731~0.832,P<0.05)。结论低血清镁水平是CKD患者发生AS的影响因素,低血清镁水平可能导致CKD患者发生AS风险增加。

Objective To explore the correlation between hypomagnesemia and atherosclerosis(AS)in patients with chronic kidney disease(CKD).Methods 402 patients with CKD stage 5 who were hospitalized in the department of nephrology of Beijing Road Medical District,General Hospital of Xinjiang Military Region from January 2017 to January 2020 were selected,and the patients were divided into AS group(140 cases)and non AS group(262 cases)according to the results of carotid ultrasound,and the clinical examination indexes of the two groups were compared.The serum magnesium,hypersensitive C-reactive protein(hs-CRP),carotid intima-media thickness(IMT)and estimated glomerular filtration rate(eGFR)were compared between the two-groups.The independent risk factors for CKD patients complicated with AS were analyzed by multivariate Logistic regression.The correlation between serum magnesium and AS grade,hs-CRP,IMT and eGFR was analyzed.The predictive value of hypomagnesemia for AS in CKD patients was analyzed by receiver operating characteristic(ROC)curve.Results The proportion of patients with hypertension in AS group was higher,and the levels of LDL-C,hs-CRP,uric acid(UA)and IMT were significantly higher than those in non AS group,while the levels of serum magnesium and eGFR were lower than those in non AS group(χ^(2)=4.109,3.584,10.877,2.459,26.035,5.652,7.040;P<0.05).Serum magnesium,hs-CRP,IMT and eGFR were all influence factors for CKD patients with AS[OR(95%CI)=3.221(2.635-5.548),6.582(4.235-7.634),8.917(6.344-9.213),3.165(2.251-5.337);P<0.05].The area under the curve of serum magnesium predicting the occurrence of AS in CKD patients was 0.784(95%CI=0.731-0.832),P<0.05.Conclusion Low serum magnesium level is an influence factor for AS in CKD patients.Low serum magnesium level may increase the risk of AS in CKD patients.