维持性血液透析患者心血管钙化进展的相关影响因素分析

发布时间：2018-08-04 10:15

【摘要】：目的:探讨维持性血液透析(MHD)患者心血管钙化进展的影响因素。方法:选择MHD6月的患者104例,完善相关实验室检查,胸部螺旋CT检测冠状动脉钙化评分(CACS,Agston法),腹部侧位平片检测腹主动脉钙化评分(AACS,Kauppila法),心脏超声检测心脏瓣膜钙化情况。随访观察3年,探讨心血管钙化进展情况及其影响因素。结果:随访基线时钙化总阳性率为69.23%,随访3年后钙化总阳性率升至81.18%,CACS、AACS、心脏瓣膜钙化均较基线明显加重。Logistic回归分析显示舒张早期和舒张晚期二尖瓣口最大血液速度之比(E/A值)、时间平均血磷、时间平均钙磷乘积、基线CACS、碳酸钙的使用均是CACS进展的独立危险因素(P0.05)。研究期间17例(16.34%)患者死亡,因心脑血管疾病死亡患者基线钙化情况更为严重。结论:MHD患者心血管钙化发生率高,且随透析时间延长逐年加重,临床血磷、钙磷乘积等指标控制达标情况及基线CAC等均影响远期CAC进展。
[Abstract]:Objective: to investigate the influencing factors of cardiovascular calcification in patients with maintenance hemodialysis (MHD). Methods: 104 patients with MHD6 month were selected to complete the relevant laboratory examination. The coronary artery calcification score (CACS-Agston method) was detected by thoracic spiral CT, the abdominal aortic calcification score (AACS-Kauppila method) was detected by lateral abdominal plain film, and cardiac valve calcification was detected by echocardiography. To investigate the progression of cardiovascular calcification and its influencing factors. Results: the total positive rate of calcification at baseline was 69.23. After 3 years follow-up, the total positive rate of calcification increased to 81.18 CACS-AACS.The cardiac valve calcification increased significantly compared with baseline. Logistic regression analysis showed that the maximum blood velocity of mitral orifice in early diastolic and late diastolic period was higher than that in baseline. Ratio (E / A), time average blood phosphorus, Time average calcium and phosphorus product baseline CACSs and calcium carbonate use were all independent risk factors for CACS progression (P0.05). 17 patients (16.34%) died during the study period, and the baseline calcification was more serious in patients with cardiovascular and cerebrovascular diseases. Conclusion the incidence of cardiovascular calcification is high in patients with MHD, and it is aggravated year by year with the prolongation of dialysis time. The control of blood phosphorus, calcium and phosphorus product and baseline CAC all affect the long-term progress of CAC.
【作者单位】：南京大学附属金陵医院(南京总医院);南京大学附属金陵医院(南京总医院) 国家肾脏疾病临床医学研究中心全军肾脏病研究所;
【基金】：国家科技支撑计划课题(2015BAI12B02、2015BAI12B05)
【分类号】：R459.5;R54

【相似文献】