维持性血液透析患者腹主动脉钙化的相关因素分析

摘要

目的:调查维持性血液透析(MHD)患者腹主动脉钙化(AAC)的发生率,分析影响AAC发生的危险因素,尤其是血清25羟维生素D3 [25(OH) D3]水平与AAC之间的相关性. 方法:选取2015年12月至2016年12月在哈尔滨医科大学第一附属医院血液净化中心进行MHD患者,共182例,记录患者相关临床和实验室资料,腰椎侧位X线片检测患者腹主动脉钙化情况,并进行半定量评分.根据患者是否检出AAC分为钙化组与非钙化组,比较两组患者血清25(OH) D3水平及各项临床指标差异,多因素logistic回归法分析影响患者AAC发生的危险因素,并用Spearman相关法分析血清25 (OH) D3水平与AAC评分的相关性. 结果:钙化组144例(79.1％),非钙化组38例(20.9％),钙化组患者25(OH) D3水平显著低于非钙化组[(26.55±20.53) ng/mL比(46.1±26.11)ng/mL,P＜0.01].钙化组患者的年龄、透析龄、患有糖尿病、磷、钙磷乘积、碱性磷酸酶(AKP)、全段甲状旁腺激素(iPTH)、总胆固醇(TC)均明显高于非钙化组(P＜0.05).24h残余尿量、25(OH)D3、舒张压均明显低于非钙化组(P＜0.05).多因素logistic回归分析显示:年龄、体质量指数(BMI)、患有糖尿病、磷、iPTH、TC可能是发生AAC的危险因素.24h残余尿量、25 (OH) D3为保护性因素.Spearman相关分析显示,MHD患者血清25 (OH) D3水平与AAC评分之间呈负相关. 结论:MHD患者AAC发生率高,AAC的发生与年龄、BMI、患有糖尿病、磷、iPTH、TC有关,而24h残余尿量和25 (OH) D3是保护性因素,血清25 (OH) D3水平与AAC评分呈负相关.%Objective:To investigate the incidence of abdominal aortic calcification (AAC) in maintenance hemodialysis (MHD) patients,analyze the risk factors of AAC,and explore the relationship between the level of serum 25-hydroxyvitamin D3 [25(OH) D3] and AAC Score.Methodology:A total of 182 patients with maintenance hemodialysis (MHD) were enrolled in the Blood Purification Center of the First Affiliated Hospital of Harbin Medical University from December 2015 to December 2016.The clinical and laboratory data were recorded.Lumbar lateral radiographs were used to examine the calcification of the abdominal aorta (AAC) in patients with semi-quantitative scoring.Patients were divided into calcification group and non-calcified group according to whether the abdominal aorta calcification was detected.The levels of serum 25 (OH)D3 and the difference of clinical indexes were compared between the two groups.Multivariate logistic regression analysis was used to analyze the risk factors of AAC.The correlation between serum 25(OH) D3 levels and AAC scores was analyzed by Spearman correlation.Results:Calcification group 144 cases (79.1％),non-calcified group 38 cases (20.9％).The levels of 25(OH) D3 in the calcification group were significantly lower than those in the non-calcified group [(46.5± 20.53) ng/mL to (46.1 ± 26.11) ng/mL,P＜ 0.01].The age,dialysis age,diabetes mellitus,Pi,calcium and phosphorus product,AKP,iPTH and TC were significantly higher in the calcified group than those in the non-calcified group (P＜ 0.05).24h residual urine volume,25 (OH) D3,diastolic blood pressure were significantly lower than non-calcified group (P＜0.05).Multivariate logistic regression analysis showed that age,BMI,diabetes,Pi,iPTH,TC may be a risk factor for AAC.24h residual urine volume,25 (OH)D3 are protective factors.Spearman correlation analysis showed a negative correlation between serum 25(OH) D3 levels and AAC scores in MHD patients.Conclusion:The prevalence AAC in MHD patients is high,the occurrence of AAC is related to age,BMI,diabetes mellitus,Pi and iPTH,TC.24h residual urine volume,25-(OH) D3 are protective factors.Serum 25 (OH)D3 levels were negatively correlated with AAC scores.