CAJ | 학술논문

目的：探讨高龄男性慢性肾脏病（CKD）患者冠状动脉钙化的相关因素。方法选取2011年1月至2012年12月于解放军总医院住院治疗的126例高龄（≥80岁）男性非透析CKD3～5期患者，根据肾小球滤过率（GFR）分为A组[30≤GFR＜60ml/（min·1.73m2）]、B组[15≤GFR＜30ml/（min·1.73m2）]和C组[GFR＜15 ml/（min·1.73m2）]。采用多层螺旋计算机断层扫描（MSCT）确定冠状动脉钙化的程度，对比各组患者冠状动脉钙化积分（CACS）变化，分析冠状动脉钙化的相关因素。结果 C组患者心肌梗死、脑梗死的患病率高于A组和B组患者，差异有统计学意义（P＜0.05）。C组与B组和A组比较，血磷明显升高[（1.74±0.56） vs （1.52±0.39） vs （1.38±0.42）mmol/L，P＜0.01或P＜0.05]，钙磷乘积增加[（46.32±14.36） vs （40.08±10.21） vs （38.26±13.28），P＜0.05]；冠状动脉钙化积分增加[（438.56±63.22） vs （316.82±77.30） vs （262.50±81.92），P＜0.01或P＜0.05]，差异有统计学意义。Spearman相关分析显示，CACS与患者年龄（r＝0.2218，P＜0.05）、血磷（r＝0.2313，P＜0.05）和钙磷乘积（r＝0.2450，P＜0.05）呈正相关，与体质量指数（r＝-0.1956，P＜0.05）和GFR（r＝-0.4462，P＜0.01）呈负相关。结论高龄男性CKD患者冠状动脉钙化发生率高。年龄、体质量指数、肾功能和钙磷代谢紊乱均与冠状动脉钙化发生相关。
목적：탐토고령남성만성신장병（CKD）환자관상동맥개화적상관인소。방법선취2011년1월지2012년12월우해방군총의원주원치료적126례고령（≥80세）남성비투석CKD3～5기환자，근거신소구려과솔（GFR）분위A조[30≤GFR＜60ml/（min·1.73m2）]、B조[15≤GFR＜30ml/（min·1.73m2）]화C조[GFR＜15 ml/（min·1.73m2）]。채용다층라선계산궤단층소묘（MSCT）학정관상동맥개화적정도，대비각조환자관상동맥개화적분（CACS）변화，분석관상동맥개화적상관인소。결과 C조환자심기경사、뇌경사적환병솔고우A조화B조환자，차이유통계학의의（P＜0.05）。C조여B조화A조비교，혈린명현승고[（1.74±0.56） vs （1.52±0.39） vs （1.38±0.42）mmol/L，P＜0.01혹P＜0.05]，개린승적증가[（46.32±14.36） vs （40.08±10.21） vs （38.26±13.28），P＜0.05]；관상동맥개화적분증가[（438.56±63.22） vs （316.82±77.30） vs （262.50±81.92），P＜0.01혹P＜0.05]，차이유통계학의의。Spearman상관분석현시，CACS여환자년령（r＝0.2218，P＜0.05）、혈린（r＝0.2313，P＜0.05）화개린승적（r＝0.2450，P＜0.05）정정상관，여체질량지수（r＝-0.1956，P＜0.05）화GFR（r＝-0.4462，P＜0.01）정부상관。결론고령남성CKD환자관상동맥개화발생솔고。년령、체질량지수、신공능화개린대사문란균여관상동맥개화발생상관。
Objective To determine the factors correlated to coronary artery calcification in very old elderly male patients with chronic kidney disease (CKD). Methods A total of 126 very old male CKD patients (≥80 years old) at stages 3 to 5 who did not receive dialysis therapy admitted in Chinese PLA General Hospital from January 2011 to December 2012 were enrolled in the study, and then stratified into 3 groups based on their glomerular filtration rate (GFR): group A [30≤GFR<60ml/(min·1.73m2)], group B [15≤GFR<30ml/(min·1.73m2)] and group C [GFR<15ml/(min·1.73m2)]. Quantification of coronary artery calcification was determined by multi-slice spiral computed tomography (MSCT) for coronary artery calcification score (CACS). The relationship of coronary artery calcification to risk factors was analyzed retrospectively. Results Compared with groups B and A, the prevalence of myocardial infarction and cerebral infarction was significantly higher in group C (P<0.05), and so were the serum level of phosphorus [(1.74±0.56) vs (1.52±0.39) vs (1.38±0.42)mmol/L, P<0.01 or P<0.05], and the calcium-phosphorus product [(46.32±14.36) vs (40.08±10.21) vs (38.26±13.28), P<0.05], and CACS [(438.56±63.22) vs (316.82±77.30) vs (262.50±81.92), P<0.01 or P<0.05]. Spearman correlation analysis showed that CACS was positively correlated with age (r=0.2218, P<0.05), serum level of phosphorus (r=0.2313, P<0.05) and calcium-phosphorus product (r=0.2450, P<0.05), but negatively with body mass index (r=-0.1956, P<0.05) and GFR (r=-0.4462, P<0.01). Conclusion The prevalence of coronary artery calcification is high in very old male CKD patients. Age, body mass index, renal function and disturbance of calcium and phosphorus metabolism are correlated with the severity of coronary artery calcification.