糖尿病肾病患者心血管钙化的发生率及特点

发布时间：2018-07-04 23:06

本文选题：糖尿病肾病 + 慢性肾脏病矿物质与骨异常　；参考：《肾脏病与透析肾移植杂志》2015年03期

【摘要】：目的:观察糖尿病肾病患者心血管钙化的发生情况,并分析其影响因素。方法:选取慢性肾脏病(CKD)2~5期非透析糖尿病肾病患者270例(2期40例、3期121例、4期63例、5期46例),完善心血管钙化的相关实验室检查,选用螺旋CT评分冠状动脉钙化,腹部侧位平片评分腹主动脉钙化,心脏彩超观察心脏瓣膜钙化情况,并采用Logistic回归分析心血管钙化的相关危险因素。结果:CKD 2~5期患者血磷逐渐升高,血钙逐渐降低,全段甲状旁腺激素逐渐升高,25羟维生素D逐渐下降(P0.01)。所有患者心血管钙化发生率为70.3%,其中冠状动脉钙化、腹主动脉钙化和瓣膜钙化发生率分别为55.1%、43.4%和23.9%。CKD 2~5期心血管钙化的总发生率分别为72.5%、73.6%、66.7%和63.0%。心血管钙化与年龄、糖尿病病程、高血压病程、心血管疾病史、颈部血管粥样斑块等相关,而与性别、血脂异常、血钙、血磷、全段甲状旁腺激素及CKD分期无关。其中年龄、心脑血管疾病史和颈部血管粥样斑块是冠状动脉和腹主动脉钙化的独立危险因素,年龄是心脏瓣膜钙化的独立危险因素。结论:糖尿病肾病患者心血管钙化发生率高,在CKD 2期钙磷代谢紊乱不明显时即已出现明显钙化。心血管钙化发生率与传统心血管疾病危险因素相关,而与钙磷代谢指标及CKD分期无显著相关。
[Abstract]:Objective: to observe the occurrence of cardiovascular calcification in patients with diabetic nephropathy and analyze its influencing factors. Methods: 270 patients with chronic kidney disease (CKD) were enrolled in this study. 270 patients (40 patients with stage 2, 121 patients with stage 3, 63 patients with stage 4 and 46 patients with stage 5) were selected to improve the laboratory examination of cardiovascular calcification, and coronary artery calcification was evaluated by spiral CT. Abdominal lateral plain film was used to evaluate the calcification of abdominal aorta, cardiac color Doppler ultrasound was used to observe the calcification of heart valve, and logistic regression analysis was used to analyze the risk factors of cardiovascular calcification. Results the level of serum phosphorus, calcium and parathyroid hormone increased gradually and 25 hydroxyvitamin D decreased gradually (P0.01). The incidence of cardiovascular calcification in all patients was 70.3%. The total rates of coronary artery calcification, abdominal aortic calcification and valve calcification were 43.4% and 23.9%, respectively. The total rates of cardiovascular calcification were 72.5% 73.6% and 63.0%, respectively. Cardiovascular calcification was associated with age, diabetes, hypertension, history of cardiovascular disease, cervical atherosclerotic plaques, but not with sex, dyslipidemia, serum calcium, blood phosphorus, whole parathyroid hormone and CKD stage. Age, history of cardiovascular and cerebrovascular diseases and cervical atherosclerotic plaque were independent risk factors for calcification of coronary artery and abdominal aorta, and age was an independent risk factor for calcification of heart valve. Conclusion: the incidence of cardiovascular calcification in patients with diabetic nephropathy is high. The incidence of cardiovascular calcification was related to the risk factors of traditional cardiovascular disease, but not to the metabolic index of calcium and phosphorus and CKD stage.
【作者单位】：南京大学医学院附属金陵医院(南京军区南京总医院)肾脏科
【基金】：国家科技支撑计划课题(2013BAI09B04,2015BAI12B05) 江苏省临床医学中心项目(BL2012007) 南京军区南京总医院院管课题(2014008)
【分类号】：R587.2;R692

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