基于生物电阻抗方法分析血液透析患者内脏脂肪面积与腹主动脉钙化的相关性研究

Correlation between visceral fat area and abdominal aortic calcification in hemodialysis patients based on bioelectrical impedance methods

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者内脏脂肪面积(visceral fat area,VFA)与腹主动脉钙化的相关性。方法采用横断面调查法,选取2019年4月至2020年5月于首都医科大学附属北京潞河医院规律血液透析且保留完整数据的患者,进行人体成分分析,排除营养不良的患者,按照腹主动脉钙化评分(Abdominal Aortic Calcification Score,AACs)将患者按照钙化程度分成4组,比较临床特点及VFA水平;采用多因素Logistic回归法分析患者腹主动脉钙化的影响因素,并通过受试者工作特征(receiver operating characteristic,ROC)曲线分析VFA水平对腹主动脉钙化的预测价值。结果本研究共纳入152例MHD患者,分为无钙化组(n=32)、轻度钙化组(n=45)、中度钙化组(n=54)以及重度钙化组(n=21);4组患者的血磷、全段甲状旁腺素(intact parathyroid hormone,iPTH)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)、VFA以及是否合并糖尿病指标比较,差异有统计学意义(P<0.05)。单因素相关分析显示非营养不良的MHD患者AACs评分与是否合并糖尿病、血磷、iPTH、VFA水平等均呈显著正相关(r=0.188、0.238、0.223、0.392,P<0.05),与HDL-C水平呈显著负相关(r=-0.228,P<0.05);多因素Logistic回归分析显示,VFA以及血磷是MHD患者发生腹主动脉钙化的独立危险因素。ROC曲线显示,非营养不良的MHD患者体内VFA预测腹主动脉钙化的曲线下面积(area under the curve,AUC)为0.725(P<0.05),具有较高的预测价值。结论对于非营养不良的MHD患者,VFA升高与腹主动脉钙化的严重程度相关,是腹主动脉钙化的独立危险因素,可能成为预测患者发生腹主动脉钙化的生物学指标。

Objective To investigate the correlation between visceral fat area(VFA)and abdominal aortic calcification in patients with maintenance hemodialysis(MHD).Methods Via cross-sectional survey,MHD patients in Beijing Luhe Hospital,Capital Medical University from April 2019 to May 2020 with complete data were selected and subjected to body composition analysis,excluding malnourished patients.The patients were divided into 4 groups according to the degree of calcium by Abdominal Aortic Calcification Score(AACs),and the clinical characteristics and VFA level were compared.Multivariate Logistic regression was used to analyze the risk factors of abdominal aortic calcification(AAC),and the predictive value of VFA level to abdominal aortic calcification was analyzed by receiver operating characteristic(ROC)curve.Results A total of 152 patients with MHD were included in this study and divided into non-AAC group(n=32),mild AAC group(n=45),moderate AAC group(n=54)and severe AAC group(n=21).There were statistically significant differences in serum phosphorus,intact parathyroid hormone(iPTH),high density lipoprotein-cholesterol(HDL-C),VFA and whether diabetes mellitus was combined among 4 groups(P<0.05).Univariate correlation showed that AACs score of non-malnourished MHD patients was significantly positively correlated with diabetes,serum phosphorus,iPTH,and VFA level(r=0.188,0.238,0.223,0.392,P<0.05),was negatively correlated with HDL-C level(r=-0.228,P<0.05).Multivariate Logistic regression analysis showed that VFA and serum phosphorus were independent risk factors for AAC in MHD patients.ROC curve showed that the area under curve(AUC)of VFA in non-malnourished MHD patients for predicting AAC was 0.725(P<0.05),which had high predictive value.Conclusion For non-malnourished MHD patients,elevated VFA is associated with the severity of AAC and is an independent risk factor for AAC,which may be a biological indicator for predicting the occurrence of AAC.