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目的:调查腹膜透析(PD)患者心血管钙化的发生率并分析影响因素。方法:选取2013年12月至2014年8月的PD患者,测定其血清钙、磷、全段甲状旁腺激素(i PTH),评估患者透析状态;应用多层螺旋CT计算冠状动脉钙化积分(CACS,Agatston方法),腹部侧位平片计算腹主动脉钙化积分(AACS,Kauppila方法),超声心动图检测心脏瓣膜钙化(CVC)。采用Logistic回归分析心血管钙化的相关危险因素。结果:150例入选PD患者血清校正总钙、血磷、血i PTH的达标率分别为58.0%、46.0%、23.3%(参照中华医学会肾脏病学分会发布的指导)。共计57.3%患者发生钙化,其中CAC、AAC、CVC的发生率分别为40.7%、32.7%、27.3%。任意部位钙化的发生率(除个别组别外)均随着年龄、透析龄增长而增加。Logistic回归分析显示高龄(OR=1.10)、透析龄长(OR=1.03)是CAC的独立危险因素,尿素清除指数(Kt/V)(OR=0.27)是其保护性因素;高龄(OR=1.07)、高磷(OR=1.94)是CVC的独立危险因素。结论:尽管本组PD患者有较低的心血管钙化发生率(CAC 40.7%,AAC32.7%,CVC 27.3%),但高磷血症、i PTH异常仍很突出。高龄、透析龄长、高磷仍是钙化的传统危险因素。
Objective: To investigate the incidence of cardiovascular calcification in peritoneal dialysis (PD) patients and analyze the influencing factors. Methods: PD patients from December 2013 to August 2014 were enrolled in this study. Serum calcium, phosphorus and whole-body parathyroid hormone (i PTH) were measured to assess the status of dialysis. Multi-slice spiral CT was used to calculate coronary artery calcification score CACS, Agatston method), abdominal aorta calcification score (AACS, Kauppila method), echocardiography heart valve calcification (CVC). Logistic regression analysis of cardiovascular risk factors associated with calcification. Results: The compliance rates of total serum calcium, phosphorus and blood PTH in 150 PD patients were 58.0%, 46.0% and 23.3%, respectively (refer to the guidelines issued by the Chinese Society of Nephrology Branch). A total of 57.3% of patients with calcification, including CAC, AAC, CVC were 40.7%, 32.7%, 27.3%. The incidence of calcification at any site (except for individual groups) increased with age and the age of dialysis. Logistic regression analysis showed that elderly (OR = 1.10) and long dialysis age (OR = 1.03) were independent risk factors for CAC. Kt / V (OR = 0.27) ), High phosphorus (OR = 1.94) was an independent risk factor for CVC. Conclusion: Although the incidence of cardiovascular calcification in patients with PD was lower (CAC 40.7%, AAC 32.7%, CVC 27.3%), the abnormalities of hyperphosphatemia and i PTH were still prominent. Older age, dialysis age, high phosphorus is still a traditional risk factors for calcification.