维持性血液透析患者腹主动脉钙化进展情况及危险因素分析

The progression of abdominal aortic calcification and its risk factors in maintenance hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者腹主动脉钙化(abdominal aortic calcification,AAC)进展情况及其危险因素。方法纳入2019年12月─2022年4月在北京积水潭医院进行维持性血液透析的47例患者,回顾性收集他们随访期内进行的2次腰椎定量CT图像,依次提取8个层面,采用Image J软件进行AAC评分。根据年平均AAC评分增长量将患者分为AAC缓慢进展组(n=23)和快速进展组(n=24),进行单因素及多因素分析。结果中位随访时间2.15(2.14,2.20)年,95.74%的患者出现AAC进展,初次AAC评分中位数59.55(20.03,122.46),复查AAC评分中位数进展至78.25(31.93,141.92)。与AAC缓慢进展组相比,AAC快速进展组患者吸烟比例(χ^(2)=6.715,P=0.010)、初次AAC评分(Z=-3.629,P<0.001)、时间平均血磷(t=-3.538,P=0.001)、时间平均钙磷乘积(t=-3.173,P=0.003)、时间平均全段甲状旁腺激素(t=-3.060,P=0.004)均升高,口服碳酸司维拉姆(Z=-2.122,P=0.034)和盐酸西那卡塞(Z=-2.880,P=0.004)的时间延长。多因素Logistic回归提示初次AAC评分(OR=1.020,95%CI:1.006~1.035,P=0.005)和时间平均血磷(OR=115.585,95%CI:3.412~3915.747,P=0.008)是MHD患者AAC快速进展的危险因素。结论MHD患者AAC进展速度快,高的初始AAC评分和高磷血症是MHD患者AAC快速进展的危险因素。

Objective To investigate the progression of abdominal aortic calcification(AAC)and its risk factors in maintenance hemodialysis(MHD)patients.Methods Forty-seven MHD patients treated in Beijing Jishuitan Hospital from December 2019 to April 2022 were enrolled in this study.Two lumbar quantitative CT images performed during the follow-up period were retrospectively reviewed;8 slices were sequentially extracted,and AAC score was obtained by the Image J software.According to the average annual AAC-growth,the patients were divided into slow progression group(n=23)and rapid progression group(n=24),and then analyzed using univariate and multivariate regression methods.Results The median follow-up time was 2.15(2.14,2.20)years,and 95.74%of the patients had the progression of AAC.The median baseline AAC score was 59.55(20.03,122.46),and the median follow-up AAC score was 78.25(31.93,141.92).Compared with the slow progression group,the rate of smoking(χ^(2)=6.715,P=0.010),baseline AAC score(Z=-3.629,P<0.001),time averaged serum phosphorus(t=-3.538,P=0.001),time averaged calcium and phosphorus product(t=-3.173,P=0.003),and time averaged intact parathyroid hormone(t=-3.060,P=0.004)were significantly higher,and the durations of oral sevelamer carbonate(Z=-2.122,P=0.034)and cinacalcet hydrochloride(Z=-2.880,P=0.004)were significantly longer in the rapid progression group.Multivariate logistic regression showed that baseline AAC score(OR=1.020,95%CI:1.006~1.035,P=0.005)and time averaged serum phosphorus(OR=115.585,95%CI:3.412~3915.747,P=0.008)were the risk factors for rapid progression of AAC in MHD patients.Conclusion AAC progresses rapidly in MHD patients.Higher baseline AAC score and hyperphosphatemia were the risk factors for rapid AAC progression in MHD patients.