【摘要】目的观察维持性血液透析(MHD)患者心脏瓣膜钙化及冠状动脉钙化情况，探讨用超声心动图检测心脏瓣膜钙化是否可以预测MHD 患者冠状动脉钙化程度。方法选取MHD 患者61 例，测定血清甲状旁腺激素(PTH)、血钙(Ca2+)、血磷(P3-)、血脂等指标。应用超声心动图检测心脏瓣膜是否存在钙化，应用64 层螺旋CT 检查冠状动脉钙化积分(CAC)情况。结果①无瓣膜钙化组CAC 中位数为524 分、一个瓣膜钙化组CAC 中位数为1006.5 分，二个瓣膜钙化组CAC 中位数为2094.5 分。②根据是否存在瓣膜钙化分组后，钙化组年龄(73.36±9.28 岁)明显大于无钙化组(61.60±14.87 岁)，钙化组CAC(1765 分)明显高于无钙化组(524 分)，P＜0.05。③低密度脂蛋白与CAC 呈正相关(r=0.308,P=0.016)。④心脏瓣膜钙化者更可能出现CAC＞1000 分(OR 值为4.995，95%可信区间0.877～28.445)。结论MHD 患者心血管钙化严重，应用超声心动图检查瓣膜钙化可以预测冠状动脉钙化程度。

【Abstract】Objective To observe valvular calcification (VC) and coronary artery calcification (CAC) in maintenance hemodialysis (MHD) patients, and to explore the possibility of VC for the diagnosis of CAC. Methods Sixty- one MHD patients were enrolled in this study. Serum phosphate, calcium and PTH were measured. Echocardiogram was used to detect VC, and multi-slice spiral CT (MSCT) was performed to assess the score of CAC. Agaston score was used for the estimation of CAC degree. Results ①The median CAC score in non-VC group, one-VC group and two-VC group were 524, 1,006.5 and 2,094.5, respectively. ②Patients’age was older in VC group (73.36±9.28 years) than in non-VC group (61.60±14.87 years). The median CAC score was 1,765 in VC group, and was 524 in non-VC group (P＜0.05). ③ Correlation analysis showed that the level of low density lipoprotein cholesterol was positively correlated with CAC score (r=0.308, P= 0.016). ④Patients with VC had a significantly greater likelihood of having a CAC score ＞1,000 (OR=4.995, 95% CI 0.877～28.445). Conclusion VC and CAC are frequently seen in MHD patients. The presence of VC detected by echocardiogram can predict the degree of CAC.