慢性肾脏疾病患者内脏脂肪和冠状动脉钙化的关系研究

摘要

目的：探讨非透析依赖性慢性肾脏疾病患者内脏脂肪和冠状动脉钙化的关系。方法选取2012年3月至2015年10月收治的非透析依赖性慢性肾脏疾病患者256例，按照三分位数原理将内脏脂肪结果取三分位数分为三组（低内脏脂肪组、中内脏脂肪组和高内脏脂肪组）。回顾性分析患者的病历资料，包括一般资料、生化检测指标、体检指标、冠状动脉钙化评分等信息，并进行统计分析。结果三组患者的冠状动脉钙化评分（ Agatston积分）及冠状动脉钙化评分分组比较，高内脏脂肪组﹥中内脏脂肪组﹥中内脏脂肪组，差异均具有显著性（均P ﹤0.05）。除高密度脂蛋白、营养不良高内脏脂肪组低于中内脏脂肪组和中内脏脂肪组外，三组患者的BMI、腰围、皮下脂肪厚度、肾小球滤过率、稳态胰岛素评价指数（ HOMA-IR）、葡萄糖、总胆固醇、超敏C反应蛋白（ hs-CRP）、肌酐、甘油三酯、白细胞计数、雌激素、瘦素、内脏脂肪素、E-选择素比较，高内脏脂肪组﹥中内脏脂肪组﹥中内脏脂肪组，差异均具有显著性（均P ﹤0.05）。基于内脏脂肪或腰围的调整Logistic回归分析预测冠状动脉钙化分析结果表明，内脏脂肪OR值（95％CI）=1.40（1.00~3.26），腰围OR值（95％CI）=1.01（0.02~1.05），并且调整混杂因素后，两者模型1到模型5 OR值均逐渐增高。结论腹部脂肪与非透析依赖性慢性肾脏疾病患者冠状动脉钙化密切相关，提示其在尿毒症患者心血管事件预测的潜在作用。%Objective To observe the relationship between visceral fat and coronary artery calcification in patients with non dialysis de-pendent chronic kidney disease. Methods 256 cases of non dialysis dependent chronic kidney disease in our hospital from March 2012 to October were selected. SPSS 17. 0 statistics software were used to divide the patients into three group(low visceral fat group,medium visceral fat group and high visceral fat group). The patientˊs medical records were analyzed retrospectively,including general information,biochemical indexes,physical examination indexes and coronary artery calcification score. Results The three groups of patients with coronary artery calcification score( Agatston score)and coronary artery calcification score groups had statistically significant difference( P ﹤0. 05). BMI,waist circumference,malnutrition, subcutaneous fat thickness,glomerular filtration rate,HOMA - IR,glucose,total cholesterol,high density lipoprotein,C - reactive protein ( hsCRP),creatinine,triglyceride,white blood cell count,estrogen and leptin,visceral fat element,E-selectin in there groups were statistical significant difference( P ﹤0. 05). Based on the visceral fat or waist circumference adjusted logistic regression analysis for the prediction of coro-nary artery calcification analysis results showed that visceral fat OR value[95%CI=1. 40(1. 00 ~3. 26)]and waist circumference OR value [95%CI=1. 01(0. 02~1. 05)]and adjustment for confounding factors,both model 1 to model 5 OR values were gradually increased. Conclu-sion Abdominal fat is closely related to coronary artery calcification in patients with non dialysis dependent chronic kidney disease,which indi-cates the potential role of cardiovascular events in the prediction of cardiovascular events in uremic patients.