ISSN 1006-298X      CN 32-1425/R

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肾脏病与透析肾移植杂志 ›› 2015, Vol. 24 ›› Issue (5): 435-440.

• 论文 • 上一篇    下一篇

腹膜透析患者心血管钙化的发生率及影响因素

  

  • 出版日期:2015-10-28 发布日期:2015-10-30

The morbidity and related factors of cardiovascular calcification  in peritoneal dialysis patients

  • Online:2015-10-28 Published:2015-10-30

摘要:

摘 要 目的:调查腹膜透析(PD)患者心血管钙化的发生率并分析相关影响因素。 方法:选取2013年12月至2014年8月 的PD患者,测定其血清钙、磷、全段甲状旁腺激素(iPTH),评估透析状态;应用多层螺旋CT计算冠状动脉钙化积分(CACS, Agatston方法),腹部侧位平片计算腹主动脉钙化积分(AACS, Kauppila方法),超声心动图检测心脏瓣膜钙化(CVC)。采用 Logistic 回归分析心血管钙化的相关危险因素。 结果:150例入选 PD患者血清校正总钙、血磷、血 iPTH 的达标率分别为58.0%、46.0%、23.3%(参照中华医学会肾脏病学分会发布的指导)。共计57.3%患者发生钙化,而CAC、AAC、CVC的发生率分别为40.7%、32.7%、27.3%。任意部位钙化的发生率(除个别组别外) 均 随着年龄、透析龄增长而增加。Logistic回归分析显示高龄(OR=1.10)、透析龄长(OR=1.03)是 CAC 的独立危险因素,而 Kt/V(OR=0.27)是其保护性因素;高龄(OR=1.07)、高磷(OR=1.94)是 CVC的独立危险因素。 结论:尽管本研究中PD患者有较低的心血管钙化发生率(CAC:40.7%,AAC:32.7%,CVC:27.3%);但高磷血症、iPTH异常仍很突出。高龄、透析龄长、高磷仍是钙化的传统危险因素。

Abstract:

ABSTRACT Objective: To explore the incidence of cardiovascular calcification and related factors in patients with peritoneal dialysis (PD) . Methodology: From December 2013 to August 2014, one hundred fifty PD patients were enrolled in this study. Laboratory measurements included serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), and dialysis status was evaluated. Coronary Artery Calcification Score (CACS) was assessed with multi-slice spiral computed tomography (MSCT, Agatston method). Abdominal Aortic Calcification Score (AACS) was assessed with lateral plain radiograph of the abdomen (Kauppila method). Echocardiography was used to detect the cardiac valve calcification (CVC). The related factors of cardiovascular calcification were analyzed by binary logistic regression. Results: Only 58.0%, 46.0% and 23.3% of 150 patients reached the target for serum Ca, P and iPTH defined by Chinese Society of Nephrology (CSN). The total 57.3% patients had calcification. The incidence of CAC, AAC and CVC was found in 40.7%, 32.7% and 27.3% patients respectively. In addition to the individual groups, the incidence of calcification of any part increased with age and dialysis vintage. Using binary logistic regression, age (OR=1.10), dialysis vintage (OR=1.03) were independent risk factors for CAC, but Kt/V as a protect factor (OR=0.27), the independent risk factors for CVC included age (OR=1.07) and serum P(OR=1.94). Conclusion: Although our PD patients had low incidence of cardiovascular calcification (CAC: 40.7%, AAC:32.7%, CVC:27.3%), hyperphosphate and abnormal iPTH were still prominent. Age, dialysis vintage and serum P were traditional risk factors for calcification in patients with PD.