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  • 易扬,路建饶,吴好,马骏,赵颖丹,宣怡,刘文瑞.慢性肾脏病患者冠状动脉钙化影响因素分析[J].第二军医大学学报,2018,39(6):621-626    [点击复制]
  • YI Yang,LU Jian-rao,WU Hao,MA Jun,ZHAO Ying-dan,XUAN Yi,LIU Wen-rui.Analysis of influencing factors of coronary artery calcification in patients with chronic kidney disease[J].Acad J Sec Mil Med Univ,2018,39(6):621-626   [点击复制]
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慢性肾脏病患者冠状动脉钙化影响因素分析
易扬1,路建饶2,吴好1,马骏1*,赵颖丹1,宣怡1,刘文瑞2
0
(1. 复旦大学附属上海市静安区中心医院肾内科, 上海 200040;
2. 上海中医药大学附属第七人民医院肾病科, 上海 200137
*通信作者)
摘要:
目的 探讨慢性肾脏病(CKD)患者发生冠状动脉钙化(CAC)的影响因素。方法 选择行冠状动脉多层螺旋计算机断层扫描检查的CKD患者181例,根据美国国家肾脏病基金会制定的肾脏病患者生存质量指导(K/DOQI)指南标准将患者为分为CKD 1期、CKD 2~3期、CKD 4~5期和维持性血液透析(MHD)4组。利用Agatston评分方法评估CAC评分,CAC评分≤10为无CAC、11~100为轻度CAC、101~400为中度CAC、>400为重度CAC。采用Spearman线性回归分析研究CKD患者发生CAC的相关因素,用多因素Cox回归分析研究CKD患者发生CAC的独立影响因素。结果 181例患者中CKD 1期44例、CKD 2~3期36例、CKD 4~5期25例、MHD 76例。CKD患者CAC发生率为55.2%(100/181),其中MHD患者CAC发生率为80.3%(61/76)。随着肾功能损害的加重,CKD患者的CAC评分增加(r=0.526,P<0.001)。CKD患者的CAC程度与其年龄、血液透析龄、平均动脉压、血尿素氮、血清肌酐、C-反应蛋白、总胆固醇、血钙、血磷、钙磷乘积、血清成纤维细胞生长因子23(FGF23)水平呈正相关(r=0.135、0.525、0.139、0.141、0.824、0.135、0.140、0.138、0.391、0.453、0.326,P均<0.05),与估算的肾小球滤过率(eGFR)、胎球蛋白A、25-羟维生素D3呈负相关(r=-0.871、-0.135、-0.138,P均<0.05);与血红蛋白、血糖、三酰甘油、碱性磷酸酶、全段甲状旁腺激素均无明显相关性(P均>0.05)。多因素Cox回归分析显示,患者的年龄、eGFR、血磷、钙磷乘积和血清FGF23水平是CKD患者发生CAC的独立影响因素[比值比(95%置信区间)分别为3.723(2.521~8.363)、0.582(0.415~0.724)、5.252(3.912~10.327)、11.243(10.185~16.836)和2.469(1.141~5.362)。结论 年龄、eGFR、血磷、钙磷乘积和血清FGF23水平是CKD患者发生CAC的独立影响因素。
关键词:  慢性肾脏病  冠状动脉钙化  钙磷乘积  成纤维细胞生长因子23
DOI:10.16781/j.0258-879x.2018.06.0621
投稿时间:2017-12-28修订日期:2018-03-28
基金项目:上海市卫生和计划生育委员会科研基金面上项目(201440543),上海市静安区卫生和计划生育委员会第三批“十百千人才”培养基金(JWRC2014G05).
Analysis of influencing factors of coronary artery calcification in patients with chronic kidney disease
YI Yang1,LU Jian-rao2,WU Hao1,MA Jun1*,ZHAO Ying-dan1,XUAN Yi1,LIU Wen-rui2
(1. Department of Nephrology, Shanghai Jing'an District Central Hospital Affiliated to Fudan University, Shanghai 200040, China;
2. Department of Nephrology, the 7th People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
*Corresponding author)
Abstract:
Objective To investigate the influencing factors of coronary artery calcification (CAC) in patients with chronic kidney disease (CKD). Methods A total of 181 CKD patients undergoing multi-slice spiral computed tomography for coronary artery were selected. The patients were divided into four groups of CKD 1 stage, CKD 2-3 stage, CKD 4-5 stage and maintenance hemodialysis (MHD) according to the kidney disease outcome quality initiative (K/DOQI) guidelines established by the National Kidney Foundation. According to the CAC scores assessed using the Agatston scoring method, the patients were divided into non-CAC group (CAC score ≤ 10), mild CAC group (CAC score 11-100), moderate CAC group (CAC score 101-400), and severe CAC group (CAC score>400). The related factors and independent influencing factors of CAC in CKD patients were analyzed by Spearman linear regression analysis and multivariate Cox regression analysis, respectively. Results Of the 181 patients, 44 were CKD 1, 36 were CKD 2-3, 25 were CKD 4-5, and 76 were MHD. The incidence of CAC in the CKD patients and MHD patients was 55.3% (100/181) and 80.3% (61/76), respectively. The CAC score of CKD patients was significantly increased with the aggravation of renal impairment (r=0.526, P<0.001). The degree of CAC in the CKD patients was positively correlated to age, dialysis duration, average arterial pressure, blood urea nitrogen, serum creatinine, C-reactive protein, total cholesterol, serum calcium, serum phosphorus, calcium-phosphorus product, and serum fibroblast growth factor 23 (FGF23) level (r=0.135, 0.525, 0.139, 0.141, 0.824, 0.135, 0.140, 0.138, 0.391, 0.453, and 0.326; all P<0.05), and negatively correlated to estimated glomerular filtration rate (eGFR), fetuin A, and 25-hydroxy vitamin D3 (r=-0.871, -0.135, and -0.138; all P<0.05); the degree of CAC was not significantly correlated with hemoglobin, blood glucose, triglyceride, alkaline phosphatase, or intact parathyroid hormone (all P>0.05). Multivariate Cox regression analysis showed that age, eGFR, serum phosphorus, calcium-phosphorus product and serum FGF23 level were the independent influencing factors of CAC in CKD patients (OR[95% CI]:3.723[2.521-8.363], 0.582[0.415-0.724], 5.252[0.415-0.724], 11.243[10.185-16.836], and 2.469[1.141-5.362]). Conclusion Age, eGFR, serum phosphorus, calciumphosphorus product and serum FGF23 level are independent influencing factors of CAC in CKD patients.
Key words:  chronic kidney disease  coronary artery calcification  calcium-phosphorus product  fibroblast growth factor 23