尿毒症透析患者心血管钙化及左心室肥厚影响因素的研究
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摘要
目的研究慢性肾脏病5期(CKD5)已透析患者,心血管钙化及左心室肥厚(LVH)的影响因素。方法选取2015年12月～2017年5月在我院行透析的患者63例设为观察组,另选e GFR>90 ml/(min·1.73m2)的慢性肾脏病患者21例设为对照组,根据有无心脏瓣膜钙化进一步分为钙化组与非钙化组。分别测量并比较两组患者血压,检测血清白蛋白(ALB)、PTH、血钙(Ca)、血磷(P)、碱性磷酸酶(ALP)、25羟维生素D[25(OH)VitD]、成纤维生长因子23(FGF23),记录患者心脏结构及功能指标、腹主动脉钙化情况,分析血磷、FGF23等与心脏瓣膜钙化及左室肥厚的关系。结果观察组较对照组患者收缩压、P、钙磷乘积、PTH、左心室心肌重量指数(LVMI)、年龄高,差异有统计学意义(P<0.05);观察组心脏瓣膜及腹主动脉钙化率均高于对照组,差异有统计学意义(P<0.05);观察组中,心脏瓣膜钙化组与非钙化组患者的年龄比较,差异有统计学意义(P<0.05);多元Logistic回归分析显示:年龄(OR=1.245,P<0.05)及透析龄(OR=1.029,P<0.05)是心脏瓣膜钙化的独立危险因素;收缩压(OR=1.228,P<0.05)是LVH的独立危险因素,收缩压与LVMI呈正相关(r=0.442)。结论透析患者更易发生心血管钙化,且年龄越大、透析时间越久越容易发生钙化,是心脏瓣膜钙化的独立危险因素,收缩压为LVH的独立危险因素,且收缩压越高LVMI水平越高。
Objective To study the influencing factors of cardiovascular calcification and left ventricular hypertrophy(LVH) in patients with chronic kidney disease 5(CKD5). Methods 63 patients who underwent dialysis in our hospital from December 2015 to May 2017 were selected as observation group, and 21 patients with chronic kidney disease with eGFR>90 ml/(min·1.73 m2) were selected as the control group. According to the presence or absence of heart valve calcification, it was further divided into calcified group and non-calcified group. The blood pressures of the two groups were measured and compared, and serum albumin(ALB), PTH, blood calcium(Ca), blood phosphorus(P), alkaline phosphatase(ALP), 25 hydroxyvitamin D [25(OH) VitD] were measured,fibroblast growth factor 23(FGF23), record the patient's cardiac structure and function indicators,abdominal aortic calcification, analyze the relationship between blood phosphorus, FGF23 and heart valve calcification and left ventricular hypertrophy.Results The systolic blood pressure, P, calcium-phosphorus product, PTH, left ventricular myocardial weight index(LVMI), and age were significantly higher in the observation group than in the control group(P <0.05). The valence rate of the heart valve and abdominal aorta in the observation group was observed,the difference was statistically significant(P<0.05). In the observation group, the age of heart valve calcification group and non-calcification group were significantly different(P<0.05); multivariate logistic regression analysis showed Age(OR=1.245, P<0.05) and dialysis age(OR=1.029, P<0.05) were independent risk factors for valvular calcification; systolic blood pressure(OR=1.228, P<0.05) was an independent risk factor for LVH. Systolic blood pressure was positively correlated with LVMI(r=0.442).Conclusion Dialysis patients are more prone to cardiovascular calcification, and the older the dialysis time, the more prone to calcification, which is an independent risk factor for valvular calcification. Systolic blood pressure is an independent risk factor for LVH, and the higher the systolic blood pressure, the higher the LVMI level.
Objective To study the influencing factors of cardiovascular calcification and left ventricular hypertrophy(LVH) in patients with chronic kidney disease 5(CKD5). Methods 63 patients who underwent dialysis in our hospital from December 2015 to May 2017 were selected as observation group, and 21 patients with chronic kidney disease with eGFR>90 ml/(min·1.73 m2) were selected as the control group. According to the presence or absence of heart valve calcification, it was further divided into calcified group and non-calcified group. The blood pressures of the two groups were measured and compared, and serum albumin(ALB), PTH, blood calcium(Ca), blood phosphorus(P), alkaline phosphatase(ALP), 25 hydroxyvitamin D [25(OH) VitD] were measured,fibroblast growth factor 23(FGF23), record the patient's cardiac structure and function indicators,abdominal aortic calcification, analyze the relationship between blood phosphorus, FGF23 and heart valve calcification and left ventricular hypertrophy.Results The systolic blood pressure, P, calcium-phosphorus product, PTH, left ventricular myocardial weight index(LVMI), and age were significantly higher in the observation group than in the control group(P <0.05). The valence rate of the heart valve and abdominal aorta in the observation group was observed,the difference was statistically significant(P<0.05). In the observation group, the age of heart valve calcification group and non-calcification group were significantly different(P<0.05); multivariate logistic regression analysis showed Age(OR=1.245, P<0.05) and dialysis age(OR=1.029, P<0.05) were independent risk factors for valvular calcification; systolic blood pressure(OR=1.228, P<0.05) was an independent risk factor for LVH. Systolic blood pressure was positively correlated with LVMI(r=0.442).Conclusion Dialysis patients are more prone to cardiovascular calcification, and the older the dialysis time, the more prone to calcification, which is an independent risk factor for valvular calcification. Systolic blood pressure is an independent risk factor for LVH, and the higher the systolic blood pressure, the higher the LVMI level.
引文
[1]李志莲,陈源汉,梁馨苓,等.心脏瓣膜钙化在慢性肾脏病患者中的流行病学研究[J].国际泌尿系统杂志,2014,34(4):471-477.
[2]Yu L,Li H,Wang SX.Serum Magnesium and Mortality in Maintenance Hemodialysis Patients[J].Blood Purif,2017,43(1-3):31-36.
[3]Takahashi H,Ishii H,Aoyama T,et al.Association of cardiac valvular calcifications and Creative protein with cardiovascular mortality in incident hemodialysis patients:a Japanese cohort study[J].Am J Kidney Dis,2013,61(2):254-261.
[4]Nkomo VT,Gardin JM,Skelton TN,et al.Burden of valvular heart diseases:a population-based study[J].Lancet,2006,368(9540):1005-1011.
[5]Avila-Diaz M,Mora-Villalpando C,Prado-Uribe Mdel C,et al.De novo development of heart valve calcification in incident peritoneal dialysis patients[J].Arch Med Res,2013,44(8):638-644.
[6]Gallieni M,Caputo F,Filippini A,et al.Prevalence and progression of cardiovascular calcifications in peritoneal dialysis patients:A prospective study[J].Bone,2012,51(3):332-337.
[7]Tian Y,Feng S,Zhan Z,et al.Risk Factors for New-Onset Cardiac Valve Calcification in Patients on Maintenance Peritoneal Dialysis[J].Cardiorenal Medicne,2016,6(2):150-158.
[8]Sarmento-Dias M,Santosaraújo C,Poínhos R,et al.Fibroblast growth factor 23 is associated with left ventricular hypertrophy,not with uremic vasculopathy in peritoneal dialysis patients[J].Clinical Nephrology,2016,85(3):135-141.
[9]Scialla JJ,Lau WL,Reilly MP,et al.Fibroblast growth factor 23is not associated with and does not induce arterial calcification[J].Kidney Int,2013,83(6):1159-1168.
[10]Kadiri Mel M,Nechba RB,Zajjari YR,et al.Association of adequate dialysis parameters with left ventricular hypertrophy in hemodialysia patients[J].Saudi J Kidney Dis Transpl,2011,22(6):1133-1141.
[11]Shanahan CM,Crouthamel MH,Kapustin A,et al.Arterial calcification in chronic kidney disease:Key roles for calcium and phosphate[J].Circ Res,2011,109(6):697-711.
[12]James PA,Oparils,Carter BL,et al.2014 evidence-based guideline for the management of high blood pressure in adults:report from the panel menbers appointed to the Eighth Joint National Committee(JNC 8)[J].JAMA,2014,311(5):507-520.
[2]Yu L,Li H,Wang SX.Serum Magnesium and Mortality in Maintenance Hemodialysis Patients[J].Blood Purif,2017,43(1-3):31-36.
[3]Takahashi H,Ishii H,Aoyama T,et al.Association of cardiac valvular calcifications and Creative protein with cardiovascular mortality in incident hemodialysis patients:a Japanese cohort study[J].Am J Kidney Dis,2013,61(2):254-261.
[4]Nkomo VT,Gardin JM,Skelton TN,et al.Burden of valvular heart diseases:a population-based study[J].Lancet,2006,368(9540):1005-1011.
[5]Avila-Diaz M,Mora-Villalpando C,Prado-Uribe Mdel C,et al.De novo development of heart valve calcification in incident peritoneal dialysis patients[J].Arch Med Res,2013,44(8):638-644.
[6]Gallieni M,Caputo F,Filippini A,et al.Prevalence and progression of cardiovascular calcifications in peritoneal dialysis patients:A prospective study[J].Bone,2012,51(3):332-337.
[7]Tian Y,Feng S,Zhan Z,et al.Risk Factors for New-Onset Cardiac Valve Calcification in Patients on Maintenance Peritoneal Dialysis[J].Cardiorenal Medicne,2016,6(2):150-158.
[8]Sarmento-Dias M,Santosaraújo C,Poínhos R,et al.Fibroblast growth factor 23 is associated with left ventricular hypertrophy,not with uremic vasculopathy in peritoneal dialysis patients[J].Clinical Nephrology,2016,85(3):135-141.
[9]Scialla JJ,Lau WL,Reilly MP,et al.Fibroblast growth factor 23is not associated with and does not induce arterial calcification[J].Kidney Int,2013,83(6):1159-1168.
[10]Kadiri Mel M,Nechba RB,Zajjari YR,et al.Association of adequate dialysis parameters with left ventricular hypertrophy in hemodialysia patients[J].Saudi J Kidney Dis Transpl,2011,22(6):1133-1141.
[11]Shanahan CM,Crouthamel MH,Kapustin A,et al.Arterial calcification in chronic kidney disease:Key roles for calcium and phosphate[J].Circ Res,2011,109(6):697-711.
[12]James PA,Oparils,Carter BL,et al.2014 evidence-based guideline for the management of high blood pressure in adults:report from the panel menbers appointed to the Eighth Joint National Committee(JNC 8)[J].JAMA,2014,311(5):507-520.