终末期肾脏病和血液透析患者心脏瓣膜钙化的影响因素分析
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摘要
目的分析终末期肾脏病和血液透析患者心脏瓣膜钙化的影响因素。方法选择安徽合肥市第三人民医院2016年1月—2018年6月收治的81例终末期肾脏病和血液透析患者,根据有无心脏瓣膜钙化将其分为钙化组(31例)及无钙化组(50例),分析终末期肾脏病和血液透析患者心脏瓣膜钙化影响的单因素,对单因素分析中P<0.05的变量纳入多因素Logistic回归分析。结果单因素分析显示,终末期肾脏病和血液透析钙化组及无钙化组的性别、舒张压、收缩压、脑血管疾病、高血压、左室射血分数、左室扩张、瓣膜关闭不全、血红蛋白、三酰甘油、甲状旁腺素、合并用药、原发病比较差异无统计学意义(P>0.05);终末期肾脏病和血液透析有钙化组及无钙化组年龄、糖尿病、透析龄、左室肥厚、腹主动脉钙化评分(AACS)、白蛋白、血磷、血钙、胆固醇、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C),C反应蛋白(C-reactive protein,CRP)比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄、糖尿病、透析龄、左室肥厚、AACS、血磷、血钙、胆固醇、LDL-C、CRP为终末期肾病和血液透析患者发生的危险因素,白蛋白及HDL-C为其保护因素(P<0.05)。结论心脏瓣膜钙化为终末期肾脏病和血液透析患者的严重并发症之一,临床应充分评估此类患者心脏瓣膜钙化的风险,并针对可调控因素进行综合干预。
Objective To analyze the influencing factors of cardiac valve calcification in patients with end-stage renal disease and hemodialysis. Methods 81 cases of patients with end-stage renal disease and hemodialysis who treated from January2016 to June 2018 in our hospital, according to the presence or absence of cardiac valve calci?cation, it was divided into 31 cases with calcification group and 50 cases without calcification group, the single factors influencing cardiac valve calcification in patients with end-stage renal disease and hemodialysis were analyzed, and variables P<0.05 in single factor analysis were included in multifactor Logistic regression. Results Univariate analysis showed that gender, diastolic blood pressure, systolic blood pressure, cerebrovascular disease, hypertension, left ventricular ejection fraction, left ventricular dilatation, and valve closure in end-stage renal disease and hemodialysis in calci?ed and non-calci?ed groups Incomplete, hemoglobin, triglyceride, combined medication, parathyroid hormone, primary disease between nd-stage renal disease and hemodialysiscal ci?cation group and no calci?cation group were no difference(P>0.05); the age, diabetes, dialysis age, left ventricular hypertrophy, abdominal aortic calcification score(AACS), albumin, serum phosphorus, serum calcium, cholesterol, LDL-C, HDL-C, and CRP in patients with end-stage renal disease and hemodialysis calci?cation group and no calci?cation group were statistically signi?cant difference in(P<0.05). multivariate logistic regression analysis showed that age, diabetes, dialysis age, left ventricular hypertrophy, AACS, serum phosphorus, serum calcium, cholesterol, LDL-C, and CRP were risk factors for end-stage renal disease and hemodialysis patients. Albumin and HDL-C as a protective factor(P<0.05). Conclusion Cardiac valve calci?cation is one of the serious complications in patients with end-stage renal disease and hemodialysis, clinical assessment of the risk of heart valve calci?cation in these patients should be fully evaluated,comprehensive interventions were conducted for regulatable factors.
Objective To analyze the influencing factors of cardiac valve calcification in patients with end-stage renal disease and hemodialysis. Methods 81 cases of patients with end-stage renal disease and hemodialysis who treated from January2016 to June 2018 in our hospital, according to the presence or absence of cardiac valve calci?cation, it was divided into 31 cases with calcification group and 50 cases without calcification group, the single factors influencing cardiac valve calcification in patients with end-stage renal disease and hemodialysis were analyzed, and variables P<0.05 in single factor analysis were included in multifactor Logistic regression. Results Univariate analysis showed that gender, diastolic blood pressure, systolic blood pressure, cerebrovascular disease, hypertension, left ventricular ejection fraction, left ventricular dilatation, and valve closure in end-stage renal disease and hemodialysis in calci?ed and non-calci?ed groups Incomplete, hemoglobin, triglyceride, combined medication, parathyroid hormone, primary disease between nd-stage renal disease and hemodialysiscal ci?cation group and no calci?cation group were no difference(P>0.05); the age, diabetes, dialysis age, left ventricular hypertrophy, abdominal aortic calcification score(AACS), albumin, serum phosphorus, serum calcium, cholesterol, LDL-C, HDL-C, and CRP in patients with end-stage renal disease and hemodialysis calci?cation group and no calci?cation group were statistically signi?cant difference in(P<0.05). multivariate logistic regression analysis showed that age, diabetes, dialysis age, left ventricular hypertrophy, AACS, serum phosphorus, serum calcium, cholesterol, LDL-C, and CRP were risk factors for end-stage renal disease and hemodialysis patients. Albumin and HDL-C as a protective factor(P<0.05). Conclusion Cardiac valve calci?cation is one of the serious complications in patients with end-stage renal disease and hemodialysis, clinical assessment of the risk of heart valve calci?cation in these patients should be fully evaluated,comprehensive interventions were conducted for regulatable factors.
引文
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[16]白冰,张银利.血液透析患者血管钙化相关因素分析及防治策略[J].中国血液净化,2017,16(6):370-372.
[17]El Baz TZ,Khamis OA,El-Shehaby A,et al.Relationship between serum osteoprotegerin and vascular calcifications in hemodialysis patients[J].Egypt Heart J,2017,69(2):149-155.
[18]冀旭,孟宇,薛泮宏.血液透析联合血液灌流对终末期肾病患者ApoC3、血脂代谢及心脏结构与功能的影响[J].内科急危重症杂志,2017,23(3):233-236.
[19]张菲菲,张雪晶,柴建,等.维持性血液透析患者血清Fetuin-A、炎症因子水平与心脏瓣膜钙化的相关性[J].山东医药,2015,55(6):37-39.
[20]常美香,刘利萍,翁敏.营养不良-炎症综合征对维持性血液透析患者心血管钙化的影响[J].中国现代医学杂志,2017,27(4):110-115.
[21]Sweigert PJ,Bansal VK,Hoppensteadt DA,et al.Inf lammatory and Metabolic Syndrome Biomarker Analysis of Vascular Outcomes in End-stage Renal Disease[J].Int JAngiol,2017,26(1):43-48.
[2]池小铿,郭颖,谭艺真,等.326例终末期肾病患者维持性血液透析的效果分析[J].热带医学杂志,2017,17(11):1 499-1 502.
[3]李英.透析患者的心血管疾病[J].中国血液净化,2014,13(7):520-522.
[4]李志莲,何朝生,陈源汉,等.心脏瓣膜钙化对维持性血液透析患者心血管预后的影响[J].南方医科大学学报,2016,36(7):941-946.
[5]Aoki J,Ikari Y.Cardiovascular disease in patients with endstage renal disease on hemodialysis[J].Ann Vasc Dis,2017,10(4):327-337.
[6]Gungor O,Kocyigit I,Yilmaz MI,et al.Role of vascular calcification inhibitors in preventing vascular dysfunction and mortality in hemodialysis patients[J].Semin Dial,2018,31(1):72-81.
[7]陈忠辉,何静.维持性血液透析患者血管钙化相关因素研究[J].蚌埠医学院学报,2016,41(9):1 207-1 210.
[8]Kobayashi S.Cardiovascular events in hemodialysis patients:challenging against vascular calcification[J].Ann Vasc Dis,2017,10(1):1-7.
[9]崔立文,徐金升,白亚玲,等.终末期肾脏病患者冠状动脉钙化的影响因素[J].中华医学杂志,2015,95(38):3 133-3 137.
[10]陈佩玲,龚德华,徐斌,等.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[J].肾脏病与透析肾移植杂志,2017,26(5):403-407.
[11]黄俊,李雪梅,杨玉玺,等.糖尿病肾病患者心脏瓣膜钙化危险因素分析[J].四川医学,2017,38(2):162-165.
[12]周丽娜,陈新,朱颖玲,等.糖尿病肾脏病维持性血液透析患者心脏瓣膜钙化易发因素分析[J].临床肾脏病杂志,2016,16(9):530-534.
[13]徐庆东,郭焕开,陈小荷,等.血液透析与腹膜透析患者心脏瓣膜钙化高危因素及对临床预后的影响[J].疑难病杂志,2016,15(11):1 139-1 142.
[14]Hajira B,Manzoor M,Samiullah M,et al.Effect of dietary counselling on the nutritional status of endstage renal disease patients[J].J Pak Med Assoc,2017,67(9):1 327-1 330.
[15]徐梦露,徐旭东.维持性血透患者高磷血症的现状与治疗进展[J].中国中西医结合肾病杂志,2016,17(6):557-559.
[16]白冰,张银利.血液透析患者血管钙化相关因素分析及防治策略[J].中国血液净化,2017,16(6):370-372.
[17]El Baz TZ,Khamis OA,El-Shehaby A,et al.Relationship between serum osteoprotegerin and vascular calcifications in hemodialysis patients[J].Egypt Heart J,2017,69(2):149-155.
[18]冀旭,孟宇,薛泮宏.血液透析联合血液灌流对终末期肾病患者ApoC3、血脂代谢及心脏结构与功能的影响[J].内科急危重症杂志,2017,23(3):233-236.
[19]张菲菲,张雪晶,柴建,等.维持性血液透析患者血清Fetuin-A、炎症因子水平与心脏瓣膜钙化的相关性[J].山东医药,2015,55(6):37-39.
[20]常美香,刘利萍,翁敏.营养不良-炎症综合征对维持性血液透析患者心血管钙化的影响[J].中国现代医学杂志,2017,27(4):110-115.
[21]Sweigert PJ,Bansal VK,Hoppensteadt DA,et al.Inf lammatory and Metabolic Syndrome Biomarker Analysis of Vascular Outcomes in End-stage Renal Disease[J].Int JAngiol,2017,26(1):43-48.