【摘要】目的评估腹膜透析(peritoneal dialysis, PD)及血液透析(hemodialysis,HD)患者冠状动脉钙化(coronary artery calcification, CAC)情况及影响因素的差异。方法按年龄及性别匹配入组透析龄超过1 年的PD 及HD 患者各38 例，螺旋CT 检测计算冠状动脉钙化积分(coronary artery calcification scoring,CACs)；按CAC 严重程度分层统计分析其临床特点、影响因素并比较差异。结果2 组患者CAC 患病率无显著差异，PD 患者CACs 显著低于HD 组(t=-3.040,P=0.003)。PD 患者严重CAC 患者存在较高比例的脑血管病或和糖尿病(χ2值分别为6.838,12.805；P 值分别为＜0.001，0.012)；CAC 程度较轻患者使用维生素D 和钙剂比例较高、低密度脂蛋白胆固醇及总胆固醇较高(χ2/F 值分别为9.318, 6.528, 6.930, 3.710；P 值分别为＜0.001，＜0.001，＜0.001，0.010)；CAC 严重程度与舒张压(diastolic blood pressure,DBP)呈负相关(F=5.170,P＜0.001)，与透析液糖负荷水平及与腹主动脉钙化患病率呈正相关(F/χ2值分别为2.900, 23.714；P值分别为0.040, ＜0.001)；多元线性回归提示CACs 与体质量指数(body mass index,BMI)呈正相关(β=2.432, P=0.030)，与DBP呈负相关(β=-2.588, P=0.018)。HD患者CAC严重程度与年龄及腹主动脉钙化患病率正相关(F值分别为4.289, 13.637; P值分别为0.005, 0.009)；多元线性回归提示CACs与BMI、血钙水平及腹主动脉钙化呈正相关(β值分别为0.606, 0.363, 0.364；P值分别为0.001, 0.027, 0.020)。结论PD 和HD 患者CAC 存在不同的临床特征和影响因素，可能需要进行个体化的侧重管理。

【Abstract】Objective To assess the differences about the situation and related factors of coronary artery calcification (CAC) in patients with peritoneal dialysis (PD) and those with hemodialysis (HD). Methods According to age and gender balance, 38 PD patients and 38 HD patients with dialysis age of more than one year were recruited in this study. CAC score was calculated after spiral CT examination. Clinical characteristics, related factors and the differences between PD patients and HD patients were analyzed based on the severity of CAC. Results The prevalence of CAC was similar between the two groups. However, CAC score
was significantly lower in PD patients than in HD patients (P=0.003). In PD patients, those with severe CAC had higher rates of cerebrovascular disease (P=0.000) and/or diabetes (P=0.012); those with mild CAC had higher rates of taking vitamin D (P= 0.000) and calcium preparations (P=0.000), and higher levels of low density lipoprotein cholesterol (P=0.000) and total cholesterol (P=0.010). The severity of CAC was negatively correlated with diastolic blood pressure (P=0.000), and positively correlated with dialysate glucose load (P=0.040) and the prevalence of abdominal aortic calcification (P=0.000). Multivariate linear regression showed that CAC score was positively correlated with BMI (P=0.030) and negatively correlated with diastolic blood pressure (P=0.018). In HD patients, the severity of CAC was positively correlated with age (P=0.005) and the prevalence of abdominal aortic calcification (P=0.009). Multivariate linear regression showed that CAC score was positively correlated with BMI (P=0.001), serum calcium (P=0.027) and the prevalence of abdominal aorta calcification (P=0.020). Conclusion Clinical characteristics and risk factors of CAC were different between PD patients and HD patients. Therefore, individualized management is required between the two groups of patients.