围透析期主动脉钙化积分对MHD患者长期生存率的预测价值

Predictive value of aortic calcification index in peri-dialysis period for long-term survival in maintenance hemodialysis patients

目的 观察维持性血液透析(maintenance hemodialysis,MHD)患者不同主动脉钙化积分(aortic calcification index,ACI)心血管不良事件发生率和死亡情况,探讨围透析期患者的ACI与心血管不良事件及死亡率的关系。方法 选取2014年7月—2018年6月在上海交通大学医学院附属第九人民医院首次开始透析治疗的维持性血液透析患者,根据初始的ACI结果将患者分成高钙化组(ACI≥10%)和低钙化组(0≤ACI<10%),观察2组患者的长期生存率和不良心脑血管事件发生率。结果 共纳入82例患者,其中73例(89.02%)患者存在不同程度的主动脉钙化表现,高钙化组的患者38例。截至观察结束,共37例(45.1%)患者死亡,其中感染[15例(40.54%)]和心脑血管不良事件[12例(32.43%)]是最主要的死亡原因。多元线性回归显示:年龄较大(β=0.214,95%CI:1.107~1.386,P<0.001)、既往心脑血管病史(β=-0.087,95%CI:0.203~4.128,P=0.039)与高ACI相关。随访至60个月时,低钙化组患者的生存率为78.2%,高钙化组患者的生存率为57.3%,2组比较有统计学差异(OR=0.359,95%CI:0.186~0.694,P=0.002)。单因素(HR=1.024,95%CI:1.003~1.045,P=0.025)和多因素(HR=1.103,95%CI:0.965~1.201,P=0.039)COX分析显示高ACI与透析患者5年死亡风险增加明显相关。多因素COX分析显示高钙化组是透析患者不良心脑血管事件发生(HR=3.935,95%CI:1.427~10.850,P=0.008)和心血管死亡(HR=6.242,95%CI:0.937~41.583,P=0.050)的危险因素。结论 围透析期患者的高主动脉钙化积分与维持性血液透析患者的长期生存率及不良心血管事件相关,需要早期关注慢性肾脏病患者的矿物质骨代谢异常并进行血管钙化监测,早期干预,延长患者透析生存期。

Objective To observe the incidence and mortality of adverse cardiovascular events in maintenance hemodialysis(MHD)patients with different aortic calcification index(ACI),and to explore the relationship between ACI and adverse cardiovascular events and mortality in patients during peri-dialysis period.Method The MHD patients beginning dialysis at the Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine from July 2014 to June 2018 were recruited.They were divided into high calcification group(ACI≥10%)and low calcification group(0≤ACI<10%)based on the first ACI examination.Long-term survival rate and incidence of adverse cardiovascular and cerebrovascular events were observed in the two groups of patients.Result This study enrolled a total of 82 patients,of which 73 cases(89%)had various degrees of aortic calcification,including 38 patients with ACI≥10%in the high calcification group.A total of 37 patients(45.1%)died at the end of follow-up;15 cases(40.54%)died of infection and 12 cases,32.43%died of adverse cardiovascular events,being the main causes of death.Multivariate linear regression showed that older age(β=0.214,95%CI:1.107~1.386,P<0.001)and history of cardiovascular and cerebrovascular diseases(β=-0.087,95%CI:0.203~4.128,P=0.039)were associated with higher ACI.After followup for 60 months,the survival rates were 78.2%and 57.3%in low ACI group and high ACI group respectively(OR=0.359,95%CI:0.186~0.694,P=0.002).Both univariate and multivariate Cox regression analyses showed a significant correlation between high ACI and higher 5-year mortality in dialysis patients(univariate regression,HR=1.024,95%CI:1.003~1.045,P=0.025;multivariate regression,HR=1.103,95%CI:0.965~1.201,P=0.039).Multivariate COX analysis also showed that ACI≥10%was the risk factor for adverse cardiovascular and cerebrovascular events(HR=3.935,95%CI:1.427~10.850,P=0.008)and death(HR=6.242,95%CI:0.937~41.583,P=0.050)in dialysis patients.Conclusion Higher ACI in peri-dialysis period is related to the long-term survival rate and adverse cardiovascular events in MHD patients.The abnormal mineral bone metabolism and vascular calcification should be monitored earlier in CKD patients,and early intervention to these abnormalities may prolong their dialysis survival period.