目的:探讨维持性血液透析(MHD)合并难治性继发性甲状旁腺功能亢进(rSHPT)患者腹主动脉钙化(AAC)的相关因素. 方法:选取2014年5月至2016年1月间于中日友好医院就诊拟行甲状旁腺切除术的rSHPT患者,记录患者一般情况,血清全段甲状旁腺激素(iPTH)、血清钙(Ca)、血清磷(P)及骨转化标志物等实验室指标,测量骨密度(BMD),根据AAC评分分为无钙化、轻度钙化、中重度钙化三组,比较三组之间的差异. 结果:82例rSHPT患者纳入研究,年龄50.99±12.98岁,透析龄88.42±50.15月,男性40例占48.8％.AAC发生率为63.4％,其中腰椎L1 ～L4对应的四段血管壁均受累20例(24.4％).男性AAC积分更高(P=0.016).与无钙化组相比,发生钙化的两组年龄更大(P＜0.001),透析龄更长(P＜0.05);轻度及中重度钙化组的Ⅰ型胶原羧基端肽(CTX)明显低于无钙化组(P＜0.05).多重线性回归分析发现:AAC与年龄(r=0.042,P＜0.001)、血清磷(r=0.438,P=0.045)呈正相关,与CTX(r=-0.100,P=0.035)呈负相关. 结论:MHD合并rSHPT患者AAC发生率高,高龄、男性、高血磷及CTX低是血管钙化的易感因素.%Objective:To investigate correlation factors of abdominal aortic calcification (AAC) in maintenance hemodialysis (MHD) patients with refractory secondary hyperparathyroidism(rSHPT).Methodology:From May 2014 to January 2016,rSHPT patients without parathyroidectomy,in China-Japan Friendship Hospital were enrolled.The demographic data and biochemical data were collected,including intact parathyroid hormone (iPTH),calcium (Ca),phosphorus (P),Bone mineral density (BMD) were measured using dual X-ray absorptiometry (DXA),AAC was evaluated using lateral X-ray plain films of abdomen.AAC severity was classified as absent (AAC =0),mild (1 ≤ AAC score ≤ 5),and moderate to severe (AAC score＞6).Results:Eighty-two rSHPT patients were included,63.4％ of them had AAC.Compared with absent calcification group,patients in the other two groups were elder (P＜0.001),the dialysis time was longer (P＜0.05),and C-telopeptide of type Ⅰ collagen(CTX) level in the absent calcification group was higher than the other groups (P＜0.05).AAC was more severe in males (P＜0.05).Multiple linear regression analysis shows that AAC was positively correlated with age (r =0.042,P ＜ 0.001) and serum phosphorus (r =0.438,P =0.045),and negatively with CTX (r=-0.100,P =0.035).Conclusion:63.4％ of MHD patients with rSHPT presented with AAC,and AAC may correlate with age,male,serum phosphorus and CTX.
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