维持性血液透析患者腹主动脉钙化的相关因素分析

发布时间：2018-05-25 19:25

本文选题：维持性血液透析 + 腹主动脉钙化　；参考：《肾脏病与透析肾移植杂志》2017年05期

【摘要】：目的:调查维持性血液透析(MHD)患者腹主动脉钙化(AAC)的发生率,分析影响AAC发生的危险因素,尤其是血清25羟维生素D_3[25(OH)D_3]水平与AAC之间的相关性。方法:选取2015年12月至2016年12月在哈尔滨医科大学第一附属医院血液净化中心进行MHD患者,共182例,记录患者相关临床和实验室资料,腰椎侧位X线片检测患者腹主动脉钙化情况,并进行半定量评分。根据患者是否检出AAC分为钙化组与非钙化组,比较两组患者血清25(OH)D_3水平及各项临床指标差异,多因素logistic回归法分析影响患者AAC发生的危险因素,并用Spearman相关法分析血清25(OH)D_3水平与AAC评分的相关性。结果:钙化组144例(79.1%),非钙化组38例(20.9%),钙化组患者25(OH)D_3水平显著低于非钙化组[(26.55±20.53)ng/m L比(46.1±26.11)ng/m L,P0.01]。钙化组患者的年龄、透析龄、患有糖尿病、磷、钙磷乘积、碱性磷酸酶(AKP)、全段甲状旁腺激素(i PTH)、总胆固醇(TC)均明显高于非钙化组(P0.05)。24h残余尿量、25(OH)D_3、舒张压均明显低于非钙化组(P0.05)。多因素logistic回归分析显示:年龄、体质量指数(BMI)、患有糖尿病、磷、i PTH、TC可能是发生AAC的危险因素。24h残余尿量、25(OH)D_3为保护性因素。Spearman相关分析显示,MHD患者血清25(OH)D_3水平与AAC评分之间呈负相关。结论:MHD患者AAC发生率高,AAC的发生与年龄、BMI、患有糖尿病、磷、i PTH、TC有关,而24h残余尿量和25(OH)D_3是保护性因素,血清25(OH)D_3水平与AAC评分呈负相关。
[Abstract]:Aim: to investigate the incidence of abdominal aortic calcification in patients with maintenance hemodialysis (HD) and analyze the risk factors affecting the occurrence of AAC, especially the correlation between serum 25 hydroxyvitamin D 3 [25(OH)D_3] and AAC. Methods: from December 2015 to December 2016, 182 patients with MHD were enrolled in the blood purification center of the first affiliated Hospital of Harbin Medical University. The clinical and laboratory data of the patients were recorded. The calcification of abdominal aorta was detected by lateral X-ray of lumbar vertebrae and semi-quantitative score was performed. Patients with AAC were divided into calcified group and non-calcified group according to whether they were detected. The serum 25(OH)D_3 levels and clinical indexes were compared between the two groups. The risk factors affecting the occurrence of AAC were analyzed by multivariate logistic regression. The correlation between serum 25(OH)D_3 level and AAC score was analyzed by Spearman correlation method. Results: there were 144 cases in calcified group and 38 cases in non-calcified group. The 25(OH)D_3 level in calcified group was significantly lower than that in non-calcified group [26.55 卤20.53)ng/m / L vs 46.1 卤26.11)ng/m / L P0.01]. The age, dialysis age, diabetes mellitus, phosphorus, calcium and phosphorus product, alkaline phosphatase (ALP), whole parathyroid hormone (PTH), total cholesterol (TCC) in calcified group were significantly higher than those in non-calcified group (P 0.05, 24 h), and diastolic blood pressure was significantly lower than that in non-calcified group (P 0.05). Multivariate logistic regression analysis showed that age, body mass index (BMI), diabetes mellitus (DM), The correlation analysis of serum 25(OH)D_3 level and AAC score showed that the serum 25(OH)D_3 level was negatively correlated with the AAC score in patients with AAC, and the 24 h residual urine volume was 25 OHH / D3 as a protective factor .Spearman correlation analysis showed that there was a negative correlation between serum 25(OH)D_3 level and AAC score in patients with AAC. Conclusion the incidence of AAC in patients with AAC is higher than that in controls. The incidence of AAC is related to the age of BMI, diabetes mellitus, and PTH TC, while 24 h residual urine volume and 25(OH)D_3 are protective factors, and the serum 25(OH)D_3 level is negatively correlated with the AAC score. [WT5HZ] [WT5 "HZ] [WT5" BZ] [WT5 "BZ]
【作者单位】：哈尔滨医科大学附属第一医院肾内科二病房;
【基金】：教育部博士点基金课题(20122307110011)
【分类号】：R459.5

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