非透析慢性肾脏病3~5期患者血管钙化发生及影响因素分析

The occurrence and influencing factors of vascular calcification in non-dialysis chronic kidney disease patients of stage 3-5

目的分析非透析慢性肾脏病(choronic kidney disease,CKD)3~5期患者血管钙化患病率及其独立相关因素。方法该研究为单中心横断面观察性研究,纳入2022年5月1日至2022年12月31日在中山大学附属第一医院肾内科住院并接受血管钙化情况评估的年龄≥18岁非透析CKD 3~5期患者。收集患者的一般资料、实验室检查资料及影像学资料,通过心电门控胸部CT(Agatston评分)、侧位腹部X线平片(Kauppila评分)、颈部大血管彩超、超声心动图分别评估患者冠状动脉、胸主动脉、腹主动脉、颈动脉和心脏瓣膜的钙化情况。比较不同CKD分期患者临床资料及各部位血管钙化情况的差异,并比较不同年龄组[青年组(18~44岁)、中年组(45~64岁)和老年组(≥65岁)]患者以及是否合并糖尿病患者各部位血管钙化情况的差异,采用Logistic回归分析法分析患者不同部分动脉钙化及总体心血管钙化的独立相关因素。结果共纳入206例患者,年龄为(51±14)岁,其中男性129例(62.6%);CKD 3期44例(21.4%),CKD 4期51例(24.8%),CKD 5期111例(53.9%)。CKD病因为慢性肾小球肾炎[104例(50.5%)]、糖尿病肾损害[35例(17.0%)]、高血压肾损害[29例(14.1%)]以及其他[38例(18.4%)]。206例患者中,131例(63.6%)患者存在心血管钙化,其中78例(37.9%)存在冠状动脉钙化,90例(43.7%)存在胸主动脉钙化,78例(37.9%)存在腹主动脉钙化,74例(35.9%)存在颈动脉钙化,20例(9.7%)存在心脏瓣膜钙化。青年、中年、老年患者总体心血管钙化患病率分别为24.6%、73.6%和97.4%,随年龄增长,各部位血管钙化患病率逐渐升高,且增高趋势均有统计学意义(均P<0.001)。CKD合并糖尿病患者总体心血管钙化患病率达92.5%(62/67),且合并糖尿病组各部位血管钙化患病率均显著高于未合并糖尿病组(均P<0.001)。多因素Logistic回归分析结果显示,年龄增长(每增加10岁,OR=2.51,95%CI 1.77~3.56,P<0.001)、高血压病史(OR=5.88,95%CI 1.57~22.10,P=0.009)和糖尿病病史(OR=4.66,95%CI 2.10~10.35,P<0.001)是患者冠状动脉钙化的独立相关因素;年龄增长(每增加10岁,OR=6.43,95%CI 3.64~11.36,P<0.001)和高血压病史(OR=6.09,95%CI 1.33~27.84,P=0.020)是患者胸主动脉钙化的独立相关因素;女性(OR=0.23,95%CI 0.07~0.72,P=0.011)、年龄增长(每增加10岁,OR=3.90,95%CI 2.42~6.29,P<0.001)、糖尿病病史(OR=5.37,95%CI 2.19~13.19,P<0.001)和血镁(OR=0.01,95%CI 0~0.35,P=0.014)是患者腹主动脉钙化的独立相关因素;同时,年龄增长和糖尿病病史还是颈动脉钙化、心脏瓣膜钙化及总体心血管钙化的独立相关因素。结论非透析CKD 3~5期患者的血管钙化患病率较高,可达63.6%,其中37.9%的患者存在冠状动脉钙化,43.7%的患者存在胸主动脉钙化,而只有9.7%的患者存在心脏瓣膜钙化。除了胸主动脉钙化以外,年龄和糖尿病是各个部位发生血管钙化的独立相关因素,而高血压是冠状动脉钙化及胸主动脉钙化的独立相关因素。

Objective To explore the prevalence and independent associated factors of vascular calcification(VC)in non-dialysis chronic kidney disease(CKD)patients of stage 3-5.Methods It was a single-center cross-sectional observational study.Non-dialysis stage 3-5 CKD patients≥18 years old who were admitted to the Department of Nephrology,the First Affiliated Hospital of Sun Yat-sen University from May 1,2022 to December 31,2022 with VC evaluation were enrolled.The patients'general information,laboratory examination and imaging data were collected.Coronary artery calcification(CAC),thoracic aorta calcification(TAC),abdominal aorta calcification(AAC),carotid artery calcification and aortic valve calcification(AVC)were evaluated by cardiac-gated electron-beam CT(EBCT)scans,lateral lumbar x-ray,cervical macrovascular ultrasound and echocardiography,respectively.The differences in clinical data and the prevalence of VC at different sites of patients with different CKD stages were compared,and the prevalence of VC at different sites of patients in different age groups[youth group(18-44 years old),middle-aged group(45-64 years old)and elderly group(≥65 years old)]and patients with or without diabetes were compared.Multivariate logistic regression analysis was used to analyse the independent associated factors of VC for different areas.Results A total of 206 patients aged(51±14)years were included,including 129(62.6%)males.There were 44 patients with CKD stage 3(21.4%),51 patients with CKD stage 4(24.8%),and 111 patients with CKD stage 5(53.9%).CKD was caused by chronic glomerulonephritis[104 cases(50.5%)],diabetic kidney damage[35 cases(17.0%)],hypertensive kidney damage[29 cases(14.1%)]and others[38 cases(18.4%)].Among 206 patients,131(63.6%)exhibited cardiovascular calcification,and the prevalence of CAC,TAC,AAC,carotid artery calcification,and AVC was 37.9%,43.7%,37.9%,35.9%and 9.7%,respectively.The overall prevalence of VC in young,middle-aged and elderly patients was 24.6%,73.6%and 97.4%,respectively.With the increase of age,the prevalence of VC in each site gradually increased,and the increasing trend was statistically significant(all P<0.001).The overall prevalence of VC in CKD patients with diabetes was 92.5%(62/67),and the prevalence of VC at each site in the patients with diabetes was significantly higher than that in the patients without diabetes(all P<0.001).Multivariate logistic regression analysis revealed that age(every 10 years increase,OR=2.51,95%CI 1.77-3.56,P<0.001),hypertension(OR=5.88,95%CI 1.57-22.10,P=0.009),and diabetes(OR=4.66,95%CI 2.10-10.35,P<0.001)were independently correlated with CAC;Age(every 10 years increase,OR=6.43,95%CI 3.64-11.36,P<0.001)and hypertension(OR=6.09,95%CI 1.33-27.84,P=0.020)were independently correlated with TAC;Female(OR=0.23,95%CI 0.07-0.72,P=0.011),age(every 10 years increase,OR=3.90,95%CI 2.42-6.29,P<0.001),diabetes(OR=5.37,95%CI 2.19-13.19,P<0.001)and serum magnesium(OR=0.01,95%CI 0-0.35,P=0.014)were independently correlated with AAC.Moreover,age and diabetes were independently correlated with carotid artery calcification,AVC and overall VC Conclusions The prevalence of VC in non-dialysis CKD patients of stage 3-5 is 63.59%,of which CAC reaches 37.9%,TAC is the most common one(43.7%),while AVC is the least one(9.7%).Age and diabetes are the independent associated factors for VC of all sites except TAC,while hypertension is an independent associated factor for both CAC and TAC.