单中心血液透析患者血管钙化情况调查及其危险因素分析

Investigation of the Vascular Calcification Situation among Maintenance Hemodialysis Patients and Analysis of Its Risk Factors in Single Center

摘要: 目的：了解单中心血液透析患者血管钙化的发生率及严重程度；分析血管钙化的危险因素。方法：对我院血液净化中心规律性维持性血液透析254例患者进行调查。采用多层螺旋CT对冠状动脉钙化进行评分，计算血管钙化的发生率，并根据评分将患者分为非钙化组和钙化组。记录患者年龄、性别、透析龄、有无糖尿病、促红素使用剂量；测定患者血红蛋白、血白蛋白、血钙、血磷、血清全段甲状旁腺素(iPTH)、25-(OH)D3、超敏C反应蛋白(hs-CRP)、血脂、碱性磷酸酶(ALP)。分析血管钙化与透析患者各临床指标的相关性，通过Logistic多因素回归分析，归纳出影响透析患者发生血管钙化的危险因素。结果：本次调查中254例透析患者，CT显示有冠状动脉钙化(钙化组)共有168例(占66.14%)，无冠状动脉钙化组(非钙化组)86例(占33.86%)。钙化组和非钙化组比较，患者血红蛋白和血白蛋白，无明显差异(P > 0.05)；钙化组年龄、透析龄、血钙、血磷、血钙磷乘积、血iPTH、ALP、hs-CRP、血脂、促红素使用剂量均明显高于非钙化组(P < 0.05)；血管钙化组患者25-(OH)D3的水平明显高于非血管钙化组；糖尿病患者和非糖尿病患者比较，动脉钙化发生率明显升高(P < 0.05)。多因素Logistic回归分析显示：血液透析患者的透析龄、年龄、促红素剂量、血钙磷乘积、iPTH、ALP以及合并糖尿病是发生血管钙化的独立危险因素(P < 0.01)。结论：维持性血液透析患者血管钙化发生率高。透析龄、年龄、促红素剂量、血脂、血钙磷乘积、iPTH、ALP以及合并糖尿病是发生血管钙化的独立危险因素。

Abstract: Objective: To assess the risk factors and analyze the incidence for vascular calcification (VC) in maintenance hemodialysis (MHD) patients in our hospital. Methods: 254 cases of MHD patients in our hemodialysis center were investigated to understand the occurrence of VC. The coronary artery calcification was scored by multi-slice spiral CT. The incidence of vascular calcification was calculat-ed. According to the score, the patients were divided into non calcification group and calcification group. The age, gender, dialysis age, diabetes mellitus and erythropoietin dosage were recorded. Hemoglobin, serum albumin, calcium, phosphorus, iPTH, 25-(OH)D3, high sensitivity C-reactive pro-tein (hs CRP), blood lipid, alkaline phosphatase (ALP) were measured to analyze the correlation between vascular calcification and clinical indicators of dialysis patients, and summarize the risk factors of vascular calcification by logistic regression analysis. Results: 168 cases (66.1%) showed coronary artery calcification by CT, 86 cases (33.86%) in non calcification group without coronary artery calcification. There was no significant difference in hemoglobin and serum albumin between calcification group and non calcification group (P > 0.05). Age, dialysis age, serum calcium, phos-phorus, calcium phosphorus product, iPTH, ALP, hs-CRP, blood lipid and erythropoietin dosage in calcified group were significantly higher than those in non calcification group (P < 0.05). The levels of 25-(OH)D3 was significantly lower than those in non calcification group (P < 0.01). The incidence of arterial calcification in diabetic patients was significantly higher than that in non diabetic pa-tients (P < 0.05). Multivariate logistic regression analysis showed that dialysis age, age, erythropoi-etin dose, calcium phosphorus product, iPTH, ALP and diabetes mellitus were independent risk factors for vascular calcification (P < 0.01). Conclusion: The incidence of vascular calcification in maintenance hemodialysis patients is high. Dialysis age, age, erythropoietin dose, blood lipid, cal-cium phosphorus product, iPTH, ALP and diabetes mellitus were independent risk factors for vas-cular calcification.