腹膜透析患者腹主动脉钙化评估及相关因素分析
복막투석환자복주동맥개화평고급상관인소분석
Assessment and risk factors of abdominal aortic calcification in peritoneal dialysis patients
  • 万方数据
    中华肾脏病杂志 중화신장병잡지

    2015年 6期 419-424 ,共6页

    周艳%方炜%严豪%黄佳颖%李振元%张贺%倪兆慧%钱家麒

    주염%방위%엄호%황가영%리진원%장하%예조혜%전가기

    腹膜透析%主动脉,腹%血管钙化%腹部侧位X线平片 腹膜透析%主動脈,腹%血管鈣化%腹部側位X線平片
    복막투석%주동맥,복%혈관개화%복부측위X선평편
    Peritoneal dialysis%Aorta,abdomina%Vascular calcification%Lateral abdominal X-ray plain film
    目的 探讨慢性肾脏病(CKD)5期行规律腹膜透析患者腹主动脉钙化(AAC)的患病率及其相关危险因素.方法 入选上海交通大学医学院附属仁济医院腹膜透析中心稳定的接受规律腹膜透析的CKD5期患者,采集患者的人口统计学资料,测定血压,检测生化指标,评估患者的残余肾功能和透析充分性,使用腹部侧位X线平片检测患者的AAC情况并进行评分.采用Logistic回归分析分析腹主动脉钙化的危险因素.结果 共有206例腹膜透析患者入选本研究,其中男性108例(52.4％),平均年龄(55.6± 15.0)岁,中位透析龄20(8,44)个月,35例(17.0％)合并糖尿病.在这206例患者中,118例(57.3％)可见腹主动脉钙化,49例(23.8％)可见严重腹主动脉钙化(钙化累及3个节段及以上).与腹主动脉无钙化的患者相比,腹主动脉钙化患者的年龄[(62.3±11.9)岁比(46.7±13.9)岁,P＜0.01]、透析龄[28(11,57)个月比16(7,29)个月,P＜0.01]较大;原发病为糖尿病肾病的比例(18.6％比6.8％,P＜0.05)和合并糖尿病的比例(23.7％比8.0％,P＜0.01)较高;脉压[52.0(44.0,66.3) mmHg比48.0(40.0,58.0) mmHg,P＜0.05]较高,舒张压[(81.4±11.7) mmHg比(88.6±14.6) mmHg,P＜0.01]、平均动脉压[(99.6±13.3) mmHg比(104.8±15.1) mmHg,P＜0.05]较低;高敏C反应蛋白[2.8(0.7,5.6)mg/L比1.1(0.3,4.4) mg/L,P＜0.05]较高;血清白蛋白[(36.9±4.5)g/L比(38.7±4.5) g/L,P＜0.01]、前白蛋白[(373.2±89.1) g/L比(404.9±74.7) g/L,P＜0.01]、高密度脂蛋白[1.1(0.9,1.4)mmol/L比1.3(0.9,1.5) mmol/L,P＜0.05]较低;总Ccr[(59.1±18.9) L·周-1·(1.73 m2)-1比(67.8±29.8) L·周-1·(1.73 m2)-1,P＜0.05]较低.Logistic回归显示年龄(OR=1.104,95％CI 1.071～1.138,P＜0.01)、钙磷乘积(OR=1.467,95％CI 1.037～ 2.074,P＜0.05)是腹膜透析患者AAC的独立危险因素,残余肾功能(OR=0.858,95％CI 0.740 ～ 0.995,P＜0.05)是保护性因素.结论 CKD5期行规律腹膜透析患者的腹主动脉钙化发生率较高,高龄、高钙磷乘积和低残余肾功能是腹膜透析患者发生腹主动脉钙化的独立危险因素.腹部侧位X线平片操作简便、经济,易于临床推广,其对腹膜透析患者预后的预测价值有待更多的随访研究.
    목적 탐토만성신장병(CKD)5기행규률복막투석환자복주동맥개화(AAC)적환병솔급기상관위험인소.방법 입선상해교통대학의학원부속인제의원복막투석중심은정적접수규률복막투석적CKD5기환자,채집환자적인구통계학자료,측정혈압,검측생화지표,평고환자적잔여신공능화투석충분성,사용복부측위X선평편검측환자적AAC정황병진행평분.채용Logistic회귀분석분석복주동맥개화적위험인소.결과 공유206례복막투석환자입선본연구,기중남성108례(52.4％),평균년령(55.6± 15.0)세,중위투석령20(8,44)개월,35례(17.0％)합병당뇨병.재저206례환자중,118례(57.3％)가견복주동맥개화,49례(23.8％)가견엄중복주동맥개화(개화루급3개절단급이상).여복주동맥무개화적환자상비,복주동맥개화환자적년령[(62.3±11.9)세비(46.7±13.9)세,P＜0.01]、투석령[28(11,57)개월비16(7,29)개월,P＜0.01]교대;원발병위당뇨병신병적비례(18.6％비6.8％,P＜0.05)화합병당뇨병적비례(23.7％비8.0％,P＜0.01)교고;맥압[52.0(44.0,66.3) mmHg비48.0(40.0,58.0) mmHg,P＜0.05]교고,서장압[(81.4±11.7) mmHg비(88.6±14.6) mmHg,P＜0.01]、평균동맥압[(99.6±13.3) mmHg비(104.8±15.1) mmHg,P＜0.05]교저;고민C반응단백[2.8(0.7,5.6)mg/L비1.1(0.3,4.4) mg/L,P＜0.05]교고;혈청백단백[(36.9±4.5)g/L비(38.7±4.5) g/L,P＜0.01]、전백단백[(373.2±89.1) g/L비(404.9±74.7) g/L,P＜0.01]、고밀도지단백[1.1(0.9,1.4)mmol/L비1.3(0.9,1.5) mmol/L,P＜0.05]교저;총Ccr[(59.1±18.9) L·주-1·(1.73 m2)-1비(67.8±29.8) L·주-1·(1.73 m2)-1,P＜0.05]교저.Logistic회귀현시년령(OR=1.104,95％CI 1.071～1.138,P＜0.01)、개린승적(OR=1.467,95％CI 1.037～ 2.074,P＜0.05)시복막투석환자AAC적독립위험인소,잔여신공능(OR=0.858,95％CI 0.740 ～ 0.995,P＜0.05)시보호성인소.결론 CKD5기행규률복막투석환자적복주동맥개화발생솔교고,고령、고개린승적화저잔여신공능시복막투석환자발생복주동맥개화적독립위험인소.복부측위X선평편조작간편、경제,역우림상추엄,기대복막투석환자예후적예측개치유대경다적수방연구.
    Objectives To evaluate the incidence and risk factors of abdominal aortic calcification (AAC) in chronic kidney disease (CKD) stage 5 patients undergoing peritoneal dialysis (PD).Methods Eligible CKD stage 5 patients undergoing PD in Renji Hospital,Shanghai Jiao Tong University School of Medicine were enrolled in present study.Demographic features,blood pressure,laboratory parameters,residual renal function (RRF),dialysis adequacy and medication were determined.Lateral abdominal X-ray plain film was used to assess AAC,and abdominal aortic calcification score (AACS) was calculated.Risk factors for AAC were analyzed by Logistic regression.Results A total of 206 PD patients aged (55.6± 15.0) years with median PD duration 20 (8,44) months were enrolled in present study.Among them,108 (52.4％) patients were males and 35(17,0％) complicated with diabetes mellitus.AAC was presented in 118 (57.3％) patients,and 49 (23.8％) patients had severe calcification (calcification involving more than 3 lumber segments).Compared to those without AAC,patients with AAC were elder [(62.3±11.9) years old vs (46.7±13.9) years old,P ＜ 0.01],had longer PD duration [28(11,57) months vs 16(7,29)months,P ＜ 0.01],higher diabetic nephropathy (18.6％ vs 6.8％,P ＜ 0.05)and diabetic incidence (23.7％ vs 8.0％,P ＜ 0.01)proportion,higher pulse pressure [52.0(44.0,66.3) mmHg vs 48.0(40.0,58.0) mmHg,P ＜ 0.05],lower diastolic blood pressure[(81.4±11.7) mmHg vs (88.6±14.6) mmHg,P ＜ 0.01] and mean arterial pressure [(99.6± 13.3) mmHg vs (104.8±15.1) mmHg,P ＜ 0.05],higher high-sensitivity C-reactive protein [2.8(0.7,5.6) mg/L vs 1.1(0.3,4.4) mg/L,P ＜ 0.05],lower serum albumin [(36.9±4.5) g/L vs (38.7±4.5) g/L,P ＜ 0.01],pre-albumin [(373.2±89.1) g/L vs (404.9±74.7) g/L,P ＜ 0.01],high density lipoprotein [1.1(0.9,1.4) mmol/L vs 1.3(0.9,1.5) mmol/L,P ＜ 0.05],and total creatinine clearance rate [(59.1 ± 18.9) L· week-1· (1.73 m2)-1 vs (67.8±29.8) L.week-1· (1.73 m2)-1,P ＜ 0.05].Logistic regression showed that old age (OR=1.104,95％CI 1.071-1.138,P ＜ 0.01) and high calcium phosphorus product (OR=1.467,95％ CI 1.037-2.074,P ＜ 0.05) were independent risk factors for AAC,while RRF (OR=0.858,95％CI 0.740 -0.995,P ＜ 0.05) as a protective factor.Conclusions AAC is prevalent in CKD stage 5 patients undergoing PD.Advancing age and high calcium phosphorus product are independent risk factors for AAC,while high RRF is a protective factor.The lateral abdominal X-ray plain film is an inexpensive,simple and promising tool for assessment of AAC,even though its prognostic value of PD patients requires more follow-up studies.
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