目的 分析慢性肾脏病3～5期患者冠状动脉钙化(coronary artery calcification score，CAC)的危险因素，探讨C-反应蛋白/白蛋白比值(C-reactive protein to albumin ratio，CAR)、碱性磷酸酶/白蛋白比值(alkaline phosphatase-to-albumin ratio，APAR)对CAC的预测价值。 方法 采用横断面调查方法，对175例慢性肾脏病3～5期患者进行回顾性研究，根据冠状动脉钙化评分(coronary artery calcification score，CACS)，将患者分成无钙化组88例(CACS 0～10分)和钙化组87例(CACS≥11分)，分析CAR、APAR在2组间差异。应用Spearman相关性分析CAR、APAR与CAC的相关性，二元Logistic回归分析CAC的危险因素，受试者工作特征曲线探讨CAR、APAR对CAC的预测价值。 结果 175例慢性肾脏病3～5期患者中CAC总检出率为49.7%。Spearman相关性分析显示CAC与CAR(r=0.416，P＜0.001)、APAR(r=0.226，P =0.003)呈正相关。二元Logistic回归分析结果显示年龄(OR =1.047，95% CI：1.012～1.083，P =0.007)、糖尿病(OR=0.132，95% CI：0.038～0.456，P=0.001)、CAR(OR =16.332，95% CI：2.415～110.447，P =0.004)、APAR(OR=1.500，95% CI：1.043～2.155，P=0.029)是CAC的独立危险因素。受试者工作特征曲线分析示CAR、APAR预测CKD 3～5期患者发生CAC时，曲线下面积分别为0.765(95%CI：0.695～0.835，P＜0.001)、0.648(95%CI:0.567～0.730，P =0.001)。 结论 CAR和APAR水平越高，慢性肾脏病3～5期患者冠脉病变程度越重；CAR和APAR可以作为CKD 3～5期患者冠脉严重程度的预测因子。
Objectives To analyze the risk factors of coronary artery calcification (CAC) in chronic kidney disease (CKD) patients at the 3~5 stage, and to investigate the value of C-reactive protein to albumin ratio (CAR) and alkaline phosphatase to albumin ratio (APAR) in the prediction of CAC. Methods This was a cross-sectional and retrospective study on the 175 CKD patients at 3~5 stage. According to the CAC score, the patients were divided no CAC group (CAC score 0~10, n=88), and CAC group (CAC score ≥11, n=87). The differences of CAR and APAR were analyzed between the two groups. Spearman correlation was used to analyze the correlation between CAR, APAR and CAC. Binary logistic regression was used to analyze the risk factors of CAC. The receiver operating characteristic (ROC) curve was used to explore the values of CAR and APAR in the prediction of CAC. Results The detection rate of CAC was 49.7% in the 175 CKD patients at 3~5 stage. Spearman correlation analysis showed that CAC was positively correlated with CAR (r=0.416, P<0.001) and APAR (r=0.226, P=0.003). Binary logistic regression analysis showed that age (OR=1.047, 95% CI: 1.012~1.083, P=0.007), diabetes (OR=0.132, 95% CI: 0.038~0.456, P=0.001), CAR(OR=16.332, 95% CI:2.415~110.447, P=0.004), and APAR (OR=1.500, 95% CI: 1.043~2.155, P=0.029) were the independent risk factors for CAC. ROC curve showed that the area under the curve were 0.765 (95% CI: 0.695~0.835, P<0.001) and 0.648 (95% CI: 25 0.567~0.730, P=0.001) for the prediction of CAC by CAR and APAR respectively. Conclusion ①The higher the values of CAR and APAR, the heavier the severity of coronary artery disease in the CKD patients at 3~5 stage. ②CAR and APAR can be used as the predictors for the severity of coronary artery disease in CKD patients at 3~5 stage.
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