老年维持性血液透析患者心血管钙化危险因素分析
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摘要
目的:调查老年维持性血液透析(MHD)患者心血管钙化发生率,分析影响老年MHD患者心血管钙化的危险因素。方法:选取2014年1月至2015年1月,于四川省15家血液透析中心透析的老年MHD患者。收集患者相关临床及实验室资料,腹部侧位X线片,骨盆X线片及心脏彩色超声心动图评估患者心血管钙化情况。根据患者是否存在腹主动脉、髂股动脉或心脏瓣膜钙化分为钙化与非钙化组,比较两组间各项临床指标差异,并利用多因素Logistic回归分析影响老年MHD患者心血管钙化的危险因素。结果:共纳入79例老年MHD患者,男性41例,女性38例,平均年龄(68.61±6.72)岁,透析龄平均(61.95±44.83)个月,糖尿病肾病占老年MHD患者原发病因首位(25.3%);②老年MHD患者心血管钙化发生率高达81.0%;钙化组(n=64)年龄、脉压差、矫正钙高于无钙化组(n=15)(P<0.05), HGB、TC水平低于无钙化组(P<0.05);③Logistic回归分析显示钙、HGB和TC是老年MHD患者心血管钙化危险因素(P<0.05);④Logistic回归分析显示年龄、高磷是老年MHD患者心脏瓣膜钙化的独立危险因素(P<0.05)。结论:老年MHD患者的心血管钙化发生率高达81.0%;高钙、高磷、低HGB和低TC是老年MHD患者心血管钙化危险因素,改善上述指标,可能会降低老年MHD患者心血管钙化发生率,减少心血管事件发生率及病死率。
Objective: To investigate the incidence of cardiovascular calcification in elderly maintenance hemodialysis(MHD) patients and alyze the risk factors of cardiovascular calcification. Methods: 79 elderly patients on MHD from 15 hemodialysis centers from January 2014 to January 2015 in Sichuan province were enrolled into this study. The clinical and laboratory data were collected.Cardiovascular calcification was determined by echocardiogram,plain X-ray films of lateral abdomen and frontal pelvis. Patients were divided into calcification group and non-calcified group according to whether the echocardiogram,abdominal aorta or iliac artery calcification was detected.The difference of clinical indexes were compared between the two groups.Multivariate logistic regression analysis was used to analyze the risk factors of Cardiovascular calcification. Results: 79 patients were enrolled in this study, including 41 male and38 female; Average age is(68.61±6.72);Diabetic nephropathy is the most important cause(25.3%)in the primary causes of MHD in elderly patients;②The prevalence Cardiovascular calcification in elderly maintenance hemodialysis is high(81.0%).The age,Pulse pressure, Calibration of Calcium were significantly higher in the calcified group than those in the non-calcified group(P<0. 05);The HGB, TC were significantly lower in the calcified group than those in the non-calcified group(P<0. 05).③ Multivariate logistic regression analysis showed that hypercalcemia,anaemia, hypocholesteremia may be a risk may be risk fators for Cardiovascular calcification in elderly maintenance hemodialysis(P<0.05);④Multivariate logistic regression analysis showed that hyperphosphatemia and age may be a risk may be risk fators for Cardiac Valve Calcification in elderly maintenance hemodialysis(P<0.05). Conclusions: The prevalence Cardiovascular calcification in elderly maintenance hemodialysis is high(81.0%),the occurrence of Cardiovascular calcification is related to hypercalcemia, hyperphosphatemia,anaemia, hypocholesteremia. This indicates elderly MHD patients can manage the cardiovascular calcification level by management of calisum,Hb,TC, which will reduce the occurance of cardiovascular events and death rate.
Objective: To investigate the incidence of cardiovascular calcification in elderly maintenance hemodialysis(MHD) patients and alyze the risk factors of cardiovascular calcification. Methods: 79 elderly patients on MHD from 15 hemodialysis centers from January 2014 to January 2015 in Sichuan province were enrolled into this study. The clinical and laboratory data were collected.Cardiovascular calcification was determined by echocardiogram,plain X-ray films of lateral abdomen and frontal pelvis. Patients were divided into calcification group and non-calcified group according to whether the echocardiogram,abdominal aorta or iliac artery calcification was detected.The difference of clinical indexes were compared between the two groups.Multivariate logistic regression analysis was used to analyze the risk factors of Cardiovascular calcification. Results: 79 patients were enrolled in this study, including 41 male and38 female; Average age is(68.61±6.72);Diabetic nephropathy is the most important cause(25.3%)in the primary causes of MHD in elderly patients;②The prevalence Cardiovascular calcification in elderly maintenance hemodialysis is high(81.0%).The age,Pulse pressure, Calibration of Calcium were significantly higher in the calcified group than those in the non-calcified group(P<0. 05);The HGB, TC were significantly lower in the calcified group than those in the non-calcified group(P<0. 05).③ Multivariate logistic regression analysis showed that hypercalcemia,anaemia, hypocholesteremia may be a risk may be risk fators for Cardiovascular calcification in elderly maintenance hemodialysis(P<0.05);④Multivariate logistic regression analysis showed that hyperphosphatemia and age may be a risk may be risk fators for Cardiac Valve Calcification in elderly maintenance hemodialysis(P<0.05). Conclusions: The prevalence Cardiovascular calcification in elderly maintenance hemodialysis is high(81.0%),the occurrence of Cardiovascular calcification is related to hypercalcemia, hyperphosphatemia,anaemia, hypocholesteremia. This indicates elderly MHD patients can manage the cardiovascular calcification level by management of calisum,Hb,TC, which will reduce the occurance of cardiovascular events and death rate.
引文
[1] Saran R,Robinson B.US renal data system 2017 annual data report: epidemiology of kidney disease in the United States.Am J Kidney Dis, 2018,71(3S1):A7.
[2] Saran R,Robinson B,Abbott KC,et al. US renal data system 2016 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis, 2017,69(3 Suppl 1):A7-A8.
[3] 赵德龙. 维持性血液透析患者流行病学调查及生存预后相关性分析[D].中国人民解放军医学院,2016.
[4] 张晓玲,白久旭,郝峻烽,等.老年维持性血液透析患者血管钙化与透析间低血压的相关性研究[J].中华保健医学杂志,2017,12:492-495.
[5] Lim CTS, Yap XH, Chung KJ, et al. Predictor of cardiovascular risks in end stage renal failure patients on maintenance dialysis. Pak J Med Sci,2015,31(6):1300-1305.
[6] 乔勤,顾波,马骏.我国与全球终末期肾脏病的流行现状[J].中国血液净化,2014,13(10):729-732.
[7] Ansell D,Castledine C,Feehally J,et al.UK renal registry report, 2010: tentori R. Mineral and bone disorder and outcomes in hemodialysis patients results from the DOPPS [J]. Semin Dial,2010,23(1): 10-14.
[8] Kim H,Kim KH,Ahn SV,et al. Risk of major cardiovascular events among incident dialysis patients:a Korean national population-based study[J].Int J Cardiol,2015,198(1):95-101.
[9] Zhang K,Cheng G,Cai X,et al.Malnutrition, a new inducer for arterial calcification in hemodialysis patients?[J] J Transl Med,2013,18;11:66.
[10] Kauppila LI, Polak JF, Cupples LA, et al. New indices to classify location,severity and progression of calcific lesions in the abdominal aorta: a 25-year follow-up study. Atherosclerosis, 1997,132: 245-250.
[11] Ding S, Schoenmakers I, Jones K, et al. Quantitative determination of vitamin Dmetabolites in plasma using UHPLC-MS/MS[J]. Anal Bioanal Chem,2010,398(2):779-789.
[12] Peres LA,Percio PP,et al. Mineral and bone disorder and vascular calcification in patients with chronic kidney disease[J].J Bras Nefrol,2014,36(2):201-207.
[13] McCullough PA,Sandberg KR,Dumler F,et al. Determinants of coronary vascular calcification in patients with chronic kidney disease and end-stage renal disease: a systematic review[J]. J Nephrol,2004,17(2):205-215.
[14] Chen HC, Wang WT, Hsi CN,et al. Abdominal aortic calcification score can predict future coronary artery disease in hemodialysis patients: a 5-year prospective cohort study[J]. BMC Nephyot,2018, 19(1):313.
[15] Yamada S, Giachelli CM. Vascular calcification in CKD-MBD: Roles for phosphate, FGF23, and Klotho[J]. Bone, 2017,100:87-93.
[16] A Masumoto,T Sonou,M Ohya,et al.Calcium vverload accelerates phosphate-induced vascular calcification via pit-1,but not the calcium-sensing receptor[J]. J Atheroscler Thromb,2017,24(7):716-724.
[17] 李康.人体心脏瓣膜钙化的临床及病理研究[D].北京协和医学院,2017.
[18] Adeney KL1, Siscovick DS,Ix JH,et al.Association of serum phosphate with vascular and valvular calcification in moderate CKD[J]. J Am Soc Nephrol, 2009,20(2):381-387.
[19] Won Suk An, Young Ki Son. Vascular calcification on plain radiographs is associated with carotid intima media thickness,malnutrition and cardiovascular events in dialysis patients: a prospective observational study[J]. BMC Nephrol,2013,29(14):27.
[20] Nurmohamed SA, Nubé MJ. Reverse epidemiology: paradoxical observations in haemodialysis patients[J]. Neth J Med,2005,63(10):376-381.
[21] Iseki KI, Yamazato M, Tozawa M, et al. Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients. Kidney Int,2002,61:1887-1893.
[22] Kalantar-Zadeh K, Block G, Humphreys MH, et al. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients.Kidney Int, 2003,63:793-808.
[23] Mehrotra R, Kopple JD: Nutritional management of maintenance dialysis patients: why aren’t we doing better? Ann Rev Nutr 2001, 21:343-379.
[24] Hayashi T,Joki N,Tanaka Y,et al. Anaemia and early phase cardiovascular events on haemodialysis[J]. Nephrology(Carlton),2015,20(Suppl 4):1-6.
[25] Ciceri P, Elli F, Braidotti P,et al. Iron citrate reduces high phosphate-induced vascular calcification by inhibiting apoptosis[J]. Atherosclerosis, 2016,254:93-101.
[2] Saran R,Robinson B,Abbott KC,et al. US renal data system 2016 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis, 2017,69(3 Suppl 1):A7-A8.
[3] 赵德龙. 维持性血液透析患者流行病学调查及生存预后相关性分析[D].中国人民解放军医学院,2016.
[4] 张晓玲,白久旭,郝峻烽,等.老年维持性血液透析患者血管钙化与透析间低血压的相关性研究[J].中华保健医学杂志,2017,12:492-495.
[5] Lim CTS, Yap XH, Chung KJ, et al. Predictor of cardiovascular risks in end stage renal failure patients on maintenance dialysis. Pak J Med Sci,2015,31(6):1300-1305.
[6] 乔勤,顾波,马骏.我国与全球终末期肾脏病的流行现状[J].中国血液净化,2014,13(10):729-732.
[7] Ansell D,Castledine C,Feehally J,et al.UK renal registry report, 2010: tentori R. Mineral and bone disorder and outcomes in hemodialysis patients results from the DOPPS [J]. Semin Dial,2010,23(1): 10-14.
[8] Kim H,Kim KH,Ahn SV,et al. Risk of major cardiovascular events among incident dialysis patients:a Korean national population-based study[J].Int J Cardiol,2015,198(1):95-101.
[9] Zhang K,Cheng G,Cai X,et al.Malnutrition, a new inducer for arterial calcification in hemodialysis patients?[J] J Transl Med,2013,18;11:66.
[10] Kauppila LI, Polak JF, Cupples LA, et al. New indices to classify location,severity and progression of calcific lesions in the abdominal aorta: a 25-year follow-up study. Atherosclerosis, 1997,132: 245-250.
[11] Ding S, Schoenmakers I, Jones K, et al. Quantitative determination of vitamin Dmetabolites in plasma using UHPLC-MS/MS[J]. Anal Bioanal Chem,2010,398(2):779-789.
[12] Peres LA,Percio PP,et al. Mineral and bone disorder and vascular calcification in patients with chronic kidney disease[J].J Bras Nefrol,2014,36(2):201-207.
[13] McCullough PA,Sandberg KR,Dumler F,et al. Determinants of coronary vascular calcification in patients with chronic kidney disease and end-stage renal disease: a systematic review[J]. J Nephrol,2004,17(2):205-215.
[14] Chen HC, Wang WT, Hsi CN,et al. Abdominal aortic calcification score can predict future coronary artery disease in hemodialysis patients: a 5-year prospective cohort study[J]. BMC Nephyot,2018, 19(1):313.
[15] Yamada S, Giachelli CM. Vascular calcification in CKD-MBD: Roles for phosphate, FGF23, and Klotho[J]. Bone, 2017,100:87-93.
[16] A Masumoto,T Sonou,M Ohya,et al.Calcium vverload accelerates phosphate-induced vascular calcification via pit-1,but not the calcium-sensing receptor[J]. J Atheroscler Thromb,2017,24(7):716-724.
[17] 李康.人体心脏瓣膜钙化的临床及病理研究[D].北京协和医学院,2017.
[18] Adeney KL1, Siscovick DS,Ix JH,et al.Association of serum phosphate with vascular and valvular calcification in moderate CKD[J]. J Am Soc Nephrol, 2009,20(2):381-387.
[19] Won Suk An, Young Ki Son. Vascular calcification on plain radiographs is associated with carotid intima media thickness,malnutrition and cardiovascular events in dialysis patients: a prospective observational study[J]. BMC Nephrol,2013,29(14):27.
[20] Nurmohamed SA, Nubé MJ. Reverse epidemiology: paradoxical observations in haemodialysis patients[J]. Neth J Med,2005,63(10):376-381.
[21] Iseki KI, Yamazato M, Tozawa M, et al. Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients. Kidney Int,2002,61:1887-1893.
[22] Kalantar-Zadeh K, Block G, Humphreys MH, et al. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients.Kidney Int, 2003,63:793-808.
[23] Mehrotra R, Kopple JD: Nutritional management of maintenance dialysis patients: why aren’t we doing better? Ann Rev Nutr 2001, 21:343-379.
[24] Hayashi T,Joki N,Tanaka Y,et al. Anaemia and early phase cardiovascular events on haemodialysis[J]. Nephrology(Carlton),2015,20(Suppl 4):1-6.
[25] Ciceri P, Elli F, Braidotti P,et al. Iron citrate reduces high phosphate-induced vascular calcification by inhibiting apoptosis[J]. Atherosclerosis, 2016,254:93-101.