【摘要】目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者骨密度的变化及与心脏瓣膜钙化(cardiac valve calcification, CVC)的相关性。方法选取在安徽医科大学第二附属医院住院的MHD患者97例，根据心脏瓣膜钙化情况分为非联合瓣膜钙化组、心脏联合瓣膜钙化组，比较2组患者骨密度差别，并使用二分类Logistic回归探讨心脏联合瓣膜钙化的影响因素。结果纳入97例MHD患者中，二尖瓣和主动脉瓣联合瓣膜钙化组30例(30.93%）；与非联合瓣膜钙化组相比，联合CVC组患者腰椎骨密度显著降低(t= -3.650, P=0.001)。与非联合瓣膜钙化组相比，联合CVC组患者年龄较大，透析龄长，中性粒细胞淋巴细胞比值(neutrophil-lymphocyte ratio, NLR)显著升高。联合CVC组患者血磷、全段甲状旁腺激素(intact parathyroid hormone, iPTH)水平较非联合钙化组显著升高 (t=3.580, 2.465, P=0.001、0.016)。二分类Logistic 回归分析发现，高磷血症(OR=16.301,P=0.001)、高iPTH 血症(OR=1.002, P =0.004)、高NLR(OR=1.561,P=0.042)、低腰椎骨密度水平(OR=0.003,P=0.010)与心脏联合瓣膜钙化相关。结论高血磷、高iPTH血症、高NLR、低腰椎骨密度是联合心脏瓣膜钙化的危险因素。
【Abstract】Objective To investigate the relationship between bone mineral density and cardiac valve calcification (CVC) in maintenance hemodialysis (MHD) patients. Method A total of 97 MHD patients admitted to The Second Hospital of Anhui Medical University were enrolled in this study. They were divided into combined CVC group and non-combined CVC group based on the manifestations in echocardiograph. Bone mineral density was compared between the two groups. Binary Logistic regression was conducted to explore the factors for combined CVC. Results Thirty patients had combined CVC in mitral and aortic valves with the
prevalence of combined CVC of 30.93%. Bone mineral density was lower in combined CVC group than in non-combined CVC group (t= -3.650, P=0.001). Older age, longer duration and higher neutrophil-lymphocyte ratio (NLR) were present in combined CVC group as compared with those in non-combined CVC group. Serum phosphate and intact parathyroid hormone (iPTH) were higher in combined CVC group than in non-combined CVC group (t=3.580 and 2.465, P=0.001 and 0.016). Binary Logistic regression found that hyperphosphatemia (OR=16.301, P=0.001), higher iPTH (OR=1.002, P=0.004), higher NLR (OR=1.561,P=0.042), and
lower bone density (OR=0.003, P=0.010) correlated with the combined CVC in MHD patients. Conclusion Hyperphosphatemia, higher iPTH, higher NLR and lower bone density were the risk factors for combined CVC in MHD patients.
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