中晚期慢性肾脏病患者冠状动脉钙化的发生情况及影响因素分析

摘要

Objective To observe the prevalence of coronary artery calcification and its influencing factors in patients with intermediate or advanced stage of chronic kidney disease (CKD). Methods Coronary artery examination by multi-slice spiral computed tomography (MSCT) was conducted in 130 patients with stages 3~5 CKD. Clinical data and related biochemical parameters were collected. The prevalence of coronary artery calcification and its influencing factors were then analyzed. Results The prevalence of coronary artery calcification was relatively high in patients with intermediate or advanced stage CKD (74/130, 56.9%). Coronary artery calcification scores (CaS) in peritoneal dialysis [143.9 (0,662.9)] and hemodialysis patients [393.8 (1.8, 1491.0)] were significantly higher than those in nondialyzed patients [0 (0, 231.53)] (P < 0.01). Age, the prevalence of cardiovascular disease and diabetes, duration of dialysis, fasting blood glucose, calcium and phosphorus product and high sensitive C-reactive protein (hsCRP) level were significantly elevated in CKD patients with coronary artery calcification compared to those without calcification. Univariate analysis showed that coronary artery CaS positively correlated with age (r=0.352, P < 0.01), fasting blood glucose (r=0.217,P < 0.05), dialysis duration (/=0.472, P < 0.01), calcium and phosphorus product (r=0.183, P < 0.05), and hsCRP (r=0.365, P < 0.01). Stepwise multiple linear regression analysis showed that older age, longer dialysis duration and higher hsCRP level were the independent risk factors for coronary artery calcification in patients with intermediate or advanced stage CKD. Conclusion The prevalence of coronary artery calcification was relatively high in patients with intermediate or advanced stage CKD, especially in those with dialysis. Age, dialysis duration and hsCRP level were the independent risk factors for coronary artery calcification in patients with intermediate or advanced stage CKD.%目的 探讨中晚期慢性肾脏病(chronic kidney disease,CKD)患者冠状动脉钙化的发生情况及影响因素.方法对上海交通大学医学院附属仁济医院的130例CKD 3～5期患者进行冠脉多层螺旋CT(multi-slice spiral computed tomography,MSCT)检查,测定冠脉钙化分数(calcification score,CaS),收集患者的临床资料和相关生化检查指标,分析冠脉钙化的发生情况及其影响因素.结果中晚期CKD患者冠脉钙化发生率较高(74/130,56.9%),腹膜透析[143.9(0,662.9)]和血液透析[393.8(1.8,1491.0)]患者的冠脉CaS显著高于非透析患者[0(0,231.53)](P＜0.01＝.根据冠脉CaS是否为0分组后发现,有冠脉钙化组的年龄、既往心血管疾病发生率、糖尿病发生率、透析龄、空腹血糖、钙磷乘积和高敏C反应蛋白 (high sensitive c-reactive protein,hsCRP)水平较无冠脉钙化组显著增高(P＜0.05＝.单因素相关分析显示冠脉CaS与患者的年龄(r=0.352,P＜0.01＝、空腹血糖( r=0.217,P＜0.05＝、透析龄(r= 0.472,P＜0.01＝、钙磷乘积(r=0.183,P ＜0.05＝和hsCRP(r=0.365,P＜0.01＝呈正相关.逐步多元线性回归分析显示年龄、透析龄和hsCRP水平是影响中晚期CKD患者冠脉钙化评分水平的独立危险因素( P＜0.05＝.结论中晚期CKD患者,特别是透析人群冠脉钙化发生率较高.年龄、透析龄和hsCRP水平与中晚期CKD 患者冠脉钙化发生密切相关.