CAJ | 학술논문

目的探讨终末期肾脏病(ESRD)患者冠状动脉(冠脉)钙化的影响因素.方法选取2014年8月至2015年3月在河北医科大学第四医院血液净化中心行规律血液透析(3次/周)的ESRD患者53例,根据冠脉钙化评分(CACs)分为钙化阴性组(13例)、钙化阳性组(轻度钙化组11例、中度钙化组12例、重度钙化组17例).收集临床一般资料,采集1周首次透析前动脉血测定白蛋白、尿酸、钙、磷、镁、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)、β2微球蛋白(β2-MG)、游离甲状旁腺素(iPTH)、碱性磷酸酶、纤维蛋白原、血红蛋白(HGB)、铁蛋白等;并同次测定透析前、透析后动脉血pH值,计算△pH(透后pH-透前pH).通过冠脉钙化评分与一般资料、血生化指标进行相关性、logistic回归等统计学分析,探讨ESRD患者冠脉钙化的发生情况及其影响因素.本研究通过河北医科大学第四医院伦理委员会批准及患者知情同意.结果冠脉钙化程度与年龄(r =0.269)、透析龄(r=0.341)、血钙水平(r=0.358)、血磷水平(r=0.186)及透前pH(r =0.275)呈正相关,与白蛋白(r=-0.192)、△pH(r=-0.302)呈负相关,均P＜0.05;logistic回归分析结果显示,年龄、透析龄、血磷及△pH是ESRD患者CACs的独立影响因素(均P＜0.05);轻、中、重度钙化3组患者的冠脉钙化部位均以左前降支受累为主(均P ＜0.05).结论 ESRD患者冠脉钙化受年龄、透析龄、血磷、△pH等多种因素的影响,其中△pH对冠脉钙化的作用主要受透前pH影响;ESRD患者冠脉钙化主要累及左前降支.
목적 탐토종말기신장병(ESRD)환자관상동맥(관맥)개화적영향인소.방법 선취2014년8월지2015년3월재하북의과대학제사의원혈액정화중심행규률혈액투석(3차/주)적ESRD환자53례,근거관맥개화평분(CACs)분위개화음성조(13례)、개화양성조(경도개화조11례、중도개화조12례、중도개화조17례).수집림상일반자료,채집1주수차투석전동맥혈측정백단백、뇨산、개、린、미、고밀도지단백담고순(HDL-C)、저밀도지단백담고순(LDL-C)、C반응단백(CRP)、β2미구단백(β2-MG)、유리갑상방선소(iPTH)、감성린산매、섬유단백원、혈홍단백(HGB)、철단백등;병동차측정투석전、투석후동맥혈pH치,계산△pH(투후pH-투전pH).통과관맥개화평분여일반자료、혈생화지표진행상관성、logistic회귀등통계학분석,탐토ESRD환자관맥개화적발생정황급기영향인소.본연구통과하북의과대학제사의원윤리위원회비준급환자지정동의.결과 관맥개화정도여년령(r =0.269)、투석령(r=0.341)、혈개수평(r=0.358)、혈린수평(r=0.186)급투전pH(r =0.275)정정상관,여백단백(r=-0.192)、△pH(r=-0.302)정부상관,균P＜0.05;logistic회귀분석결과현시,년령、투석령、혈린급△pH시ESRD환자CACs적독립영향인소(균P＜0.05);경、중、중도개화3조환자적관맥개화부위균이좌전강지수루위주(균P ＜0.05).결론 ESRD환자관맥개화수년령、투석령、혈린、△pH등다충인소적영향,기중△pH대관맥개화적작용주요수투전pH영향;ESRD환자관맥개화주요루급좌전강지.
Objective To explore risk factors for coronary artery calcification (CAC) inpatients with end-stage renal disease (ESRD).Methods A total of 53 ESRD patients undergoing regular hemodialysis (3 times a week) from August 2014 to March 2015 in the Fourth Hospital of Hebei Medical University were enrolled in the study.The patients were divided into the negative control group (13 cases) and three positive groups (11 mild calcification cases,12 moderate calcification cases and 17 severe calcification cases) based on coronary artery calcification score (CACs).Clinical data of all patients at study entry were collected.Arterial blood samples were also collected at the start of the first hemodialysis (HD) session of the week to measure the levels of serum albumin,uric acid,calcium (Ca),phosphorus (P),magnesium,high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),C reactive protein(CRP),beta-2 microglobulin(β2-MG),free parathyroid hormone (iPTH),alkaline phosphatase,fibrinogen,hemoglobin (HGB) and ferritin.Meanwhile,levels of blood pH were detected after collecting pre-and post-HD blood samples to calculate △pH (post-HD pH subtracted pre-HD pH).Logistic regression analysis was performed to analyze the correlation of CACs with clinical data and previously-reported blood biochemical indicators,followed by analysis of the incidence of CAC and influential factors in ESRD patients.Results Severity of CAC was positively correlated with age (r =0.269),HD duration (r =0.341),serum calcium (r =0.358),serum phosphorus (r =0.186) and pre-HD pH (r =0.275),but negatively correlated with serum albumin (r =-0.192) and △pH (r =-0.302),all P ＜ 0.05.Logistic regression analysis revealed that age,HD duration,serum phosphorus level and △pH were independent risk factors for CAC in ESRD patients (P ＜ 0.05).In CAC positive groups,CAC was predominantly involved in the left anterior descending artery (P ＜ 0.05,P ＜ 0.01 and P ＜ 0.01 in mild,moderate and severe calcification group,respectively).Conclusions CAC in ESRD patients seems to be affected by multiple factors,such as age,HD duration,serum phosphorus level and △pH.Moreover,△pH affects CAC mainly by pre-HD pH.Furthermore,left anterior descending artery is predominantly affected by CAC in ESRD patients.