【摘要】目的评估终末期肾病(end stage renal failure，ESRD)患者腹主动脉钙化(aorta abdominalis calcification, AAC)和心脏瓣膜钙化(cardiac valve calcification，CVC)情况及影响因素差异。方法选取2019 年10 月～2020 年12 月沧州市中心医院肾内科ESRD 患者共277名，根据AAC积分、CVC情况分为AAC和非AAC组、CVC和非CVC组、AAC 及CVC组和非AAC及非CVC组，比较其临床特点，分析影响因素。结果 AAC组较非AAC组患者老年、女性、合并糖尿病，冠状动脉粥样硬化性心脏病 (coronary atherosclerotic heart disease, CHD)、腹膜透析患者、CVC比例高，C反应蛋白(CRP)显著升高(χ2/Z 值分别8.234、30.017、9.742、11.802、4.147、18.647、- 2.807，P值分别＜0.001、＜0.001、0.002、0.001、0.042、＜0.001、0.005)；CVC 组老年、合并糖尿病和CHD、舒张压、平均动脉压、血小板、AAC 积分明显升高(χ2/t 值分别- 6.527、16.091、13.670、- 4.271、- 3.456、- 2.761、- 5.132，P 值分别＜0.001、＜0.001、＜0.001、＜0.001、0.001、0.006、＜0.001)；同时AAC、CVC 组老年、合并糖尿病和CHD、舒张压、血磷明显升高(χ2/t 值分别-7.406、16.817、16.260、-4.285、-3.178，P 值分别＜0.001、＜0.001、＜0.001、＜0.001、0.001)。多元Logistic 回归分析显示，年龄(OR=1.088, 95% CI:1.061～1.115，P＜0.001)和透析(OR=0.564, 95% CI:0.298～1.066, P=0.078)是AAC 的独立危险因素；年龄(OR=1.084, 95% CI:1.034～1.137, P=0.001),白细胞(OR=1.211,95% CI:0.990～1.469, P=0.051),既往糖尿病(OR=2.773, 95% CI:0.941～8.157, P=0.060)和CHD(OR=2.958, 95% CI:0.942～9.356, P=0.073)，AAC 积分(OR=1.173, 95% CI:1.037～1.334, P=0.012)是CVC的独立危险因素；年龄(OR=1.155,95% CI:1.071～1.263,P＜0.001)和腹膜透析(OR= 31.102, 95% CI: 2.275～424.511, P=0.010)是同时AAC 和CVC 的独立危险因素。结论ESRD 患者AAC 和CVC 相互关联，但临床特征和影响因素不同，需在临床上重点防治、侧重管理。
【Abstract】Objective To assess the status and related factors of abdominal aorta calcification (AAC) and cardiac valve calcification (CVC) in end stage renal disease (ESRD) patients. Methods A total of 277 ESRD patients admitted to the Department of Nephrology, Cangzhou Central Hospital from October, 2019 to December, 2020 were enrolled in this study. They were divided into AAC group and non-AAC group, CVC group and non-CVC group, AAC and CVC group and non-AAC and non-CVC group, based on AAC score and CVC status. Clinical characteristics and related factors were compared among the groups. Results The rates of elderly, female, diabetes, coronary atherosclerotic heart disease (CHD), peritoneal dialysis (PD), CVC and higher C-reactive protein (CRP) level were significantly higher in AAC group than in non-AAC group (P＜0.001, ＜0.001, =0.002, =0.001, =0.042, ＜0.001 and =0.005 respectively). More elderly, diabetes, CHD, and higher diastolic blood pressure, mean arterial pressure, platelet and AAC score were found in CVC group (P＜0.001,＜0.001,＜0.001,＜0.001, =0.001, =0.006 and ＜0.001 respectively). The rates of elderly, diabetes, CHD, higher diastolic blood pressure, higher serum phosphorus increased in AAC and CVC groups (P＜0.001, ＜0.001, ＜0.001, ＜0.001 and =0.001 respectively). Multivariate logistic regression showed that age and dialysis were the independent risk factors for AAC, that age, white blood cell, history of diabetes and CHD, and AAC score were the independent risk factors for CVC, and that age and PD were the independent risk factors for both AAC and CVC. Conclusions AAC and CVC were clinically correlated. However, clinical characteristics and related factors of the two vascular calcifications were different. Active prevention, treatment and individualized management are required.
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