CAJ | 학술논문

目的：观察慢性肾脏病（CKD）5期患者心瓣膜钙化情况及危险因素，探讨糖尿病对心瓣膜钙化的影响。方法选取我院CKD 5期未透析患者，按照病因分为糖尿病肾病（DKD）组和非糖尿病肾病（NDKD）组，行超声心动图检查检测心瓣膜钙化情况。记录年龄、性别、原发病、吸烟史、糖尿病史、高血压史、高血脂史、高尿酸血症史、血压、血糖、尿酸、血脂、钙、磷、甲状腺旁腺素等相关临床生化指标，对以上参数的相互关系进行统计学分析。结果（1）CKD 5期患者146例（DKD 66例，NDKD 80例）中有105例（71.91%）存在心瓣膜钙化。（2）DKD组在年龄、SBP、FBG、CHO、TG等方面较NDKD组高，而Bun、Cr、P较NDKD组低（P＜0.05）。（3）DKD组合并高血压、高血脂、高尿酸血症的发生率均较NDKD组高（P＜0.05）。（4）66例DKD患者中有49例（74.24%）存在心瓣膜钙化，80例NDKD患者56例（70.00%）存在心瓣膜钙化。DKD组在总体心瓣膜钙化发生率、单纯主动脉瓣膜钙化、二尖瓣、主动脉瓣同时钙化发生率较NDKD组高（P＜0.05），而二、三尖瓣同时钙化发生率较NDKD组低（P＜0.05），差异具有统计学意义。（5）应用多因素逐步回归分析提示年龄、FPG及胆固醇水平分别是CKD 5期患者血管钙化的主要影响因素，B值分别为0.142、0.125及0.182，t值分别为4.461、3.385及2.201（P＜0.05）。结论 CKD 5期患者普遍存在心瓣膜钙化，而DKD患者较NDKD患者具有更高的心瓣膜钙化率及更严重的心瓣膜钙化程度。年龄、高血糖、高胆固醇血症可能是引起和加重CKD 5期患者心瓣膜钙化的危险因素。糖尿病本身及高血压、高血脂、高尿酸血症等糖尿病密切相关疾病之间的相互作用对心瓣膜钙化的影响起着重要的作用。
목적：관찰만성신장병（CKD）5기환자심판막개화정황급위험인소，탐토당뇨병대심판막개화적영향。방법선취아원CKD 5기미투석환자，안조병인분위당뇨병신병（DKD）조화비당뇨병신병（NDKD）조，행초성심동도검사검측심판막개화정황。기록년령、성별、원발병、흡연사、당뇨병사、고혈압사、고혈지사、고뇨산혈증사、혈압、혈당、뇨산、혈지、개、린、갑상선방선소등상관림상생화지표，대이상삼수적상호관계진행통계학분석。결과（1）CKD 5기환자146례（DKD 66례，NDKD 80례）중유105례（71.91%）존재심판막개화。（2）DKD조재년령、SBP、FBG、CHO、TG등방면교NDKD조고，이Bun、Cr、P교NDKD조저（P＜0.05）。（3）DKD조합병고혈압、고혈지、고뇨산혈증적발생솔균교NDKD조고（P＜0.05）。（4）66례DKD환자중유49례（74.24%）존재심판막개화，80례NDKD환자56례（70.00%）존재심판막개화。DKD조재총체심판막개화발생솔、단순주동맥판막개화、이첨판、주동맥판동시개화발생솔교NDKD조고（P＜0.05），이이、삼첨판동시개화발생솔교NDKD조저（P＜0.05），차이구유통계학의의。（5）응용다인소축보회귀분석제시년령、FPG급담고순수평분별시CKD 5기환자혈관개화적주요영향인소，B치분별위0.142、0.125급0.182，t치분별위4.461、3.385급2.201（P＜0.05）。결론 CKD 5기환자보편존재심판막개화，이DKD환자교NDKD환자구유경고적심판막개화솔급경엄중적심판막개화정도。년령、고혈당、고담고순혈증가능시인기화가중CKD 5기환자심판막개화적위험인소。당뇨병본신급고혈압、고혈지、고뇨산혈증등당뇨병밀절상관질병지간적상호작용대심판막개화적영향기착중요적작용。
Objective To investigate the prevalence of cardiac valve calcification(VC) among CKD 5 stage patients and explore its risk factors among diabetic kidney disease(DKD) patients. Methods Demographic and clinical data of who newly diagnosed as CKD 5 stage and not received dialysis treatment were collected. The patients were divided into DKD patients group and non-diabetic kidney disease patients (NDKD) group. Cardiac VC was evaluated by the color Doppler ultrasonography. The clinical and laboratorial parameters related to Cardiac VC were detected and analyzed. Results (1) The present study included 66 DKD uremic patients and 80 NDKD uremic patients. Among the 146 uremic patients, 105 cases had cardiac value calcification (71.91%). (2) The DKD group showed significantly higher levels of ages, SBP, FPB, CHO, TG, and lower levels of Bun, Cr, P than the NDKD group(P<0.05). (3) The DKD group showed significantly higher proportions of hypertention,high total cholesterol and hyperuricemia than the NDKD group(P<0.05). (4) Among the 66 DKD patients, Cardiac VC was found in 49 cases (74.24%). Among the 80 NDKD patients, cardiac VC was found in 56 cases (70.00%). The prevalence of total cardiac value calcification, solitary aortic value calcification, and both aortic and mitral value calcification in DKD group was higher than that cardiac in the NDKD group (P<0.05). The prevalence of both mitral and tricuspid value calcification in DKD group was lower than that cardiac in the NDKD group (P<0.05). (5) Multiple logistic regression analysis revealed that cardiac VC was correlated with ages, hyperglycemia and high total cholesterol level(B=0.142, t=4.461, P<0.05;B=0.125, t=3.385, P<0.05; B=0.182, t=2.201, P<0.05). Conclusions The prevalence of cardiac value calcification was higher and the degree of cardiac value calcification was more severe in DKD group than that in NDKD group in CKD5 stage. Ages, Hyperglycemia and high total cholesterol maybe the risk factors of cardiac VC in patients in CKD 5 stage. Hyperglycemia,hypertention,high total cholesterol and hyperuricemia may play an important role in development and progression of cardiac VC in DKD patients in CKD5 stage.