维持性血液透析患者血管转移性钙化危险因素分析

摘要

目的 回顾性研究单个血液透析中心接受维持性血液透析(MHD)患者发生转移性钙化的危险因素.方法 纳入123例MHD患者,对2003年1月至2012年12月随访10年间发生的首要终点事件:全因死亡和心脑血管疾病死亡(如:急性心肌梗死、脑卒中等)及次要终点事件:影像学检查发现转移性钙化证据(胸片提示主动脉弓钙化、腹平片提示腹主动脉钙化、超声心动图提示心脏瓣膜钙化)的相关因素进行COX回归检验,分析临床终点事件的危险因素.结果 全因死亡的独立危险因素为男性(HR=0.225,P＜0.001)和低血清白蛋白水平(HR =0.041,P=0.001)；心脑血管因素死亡的独立危险因素为:男性(HR=0.035,P=0.035)、高钙磷乘积(HR=1.678,P=0.049)、血钙水平低(HR =0.020,P=0.030)；转移性钙化的独立危险因素只有2003年时患者的透析龄(HR=0.693,P＜0.001).结论 透析时间越长,MHD患者发生转移性血管钙化的风险越高.%Objective To study the risk factors of transference calcification in maintenance hemodialysis (MHD) patients. Methods The retrospective study enrolled 123 MHD patients in one HD center, who were followed up for 10 years from January 2003 to December 2012. The COX's regression was used to analyze the risk factors on the clinical outcomes, which included the primary events (all- cause mortality and cadio - cerebrovascular disease mortality) and the secondary events (transference calcification) . The evidences of transference calcification were defined as aortic arch calcification (AoAC), aorta abdominalis calcification (AAC), and cardiac valve calcification (CVC), which detected by plain chest radiography, lateral abdominal plain film and echocardiogram, respectively. Results Cox regression analysis showed that the independent risk factors of all - cause mortality were male gender (HR =0.225, P <0.001) and low serum albumin level ( HR =0.041, P = 0.001). The male gender (HR = 0.035, P = 0.035) and Ca ×P product (HR = 1.678, P = 0.049) were the independent risk factors of cardio - cerebrovascular mortality. The higher level of serum calcium (HR =0.020,P=0.030) might be one protective factor for cardio - cerebrovascular mortality. The dialysis vintage in 2003 was the independent risk factor of transference calcification (HR =0.693, P <0.001). Conclusion The hazard ratio will increase in MHD patients with extension of dialysis vintage.