X线平片在诊断血液透析患者血管钙化中的应用

目的 评价X线平片检测维持性血液透析（MHD）患者动脉钙化的敏感性和特异性。 方法 54例MHD患者行腹部-股骨上1/3多层螺旋CT（MSCT）平扫及侧位腹平片、骨盆片X线检测。以腰椎（L）2～3间隙为界将腹主动脉分为上段、下段。MSCT结果据钙化严重程度分为0~5级。两位放射科医师分别盲法阅片诊断。以MSCT结果为金标准,X线平片结果作为诊断性指标,评价X线平片诊断腹主动脉和髂、股动脉钙化的敏感性和特异性。 结果 MSCT结果显示,腹主动脉钙化发生率为86.1%,髂、股动脉钙化发生率为74.5%,二者差异有统计学意义（χ2 = 5.695,P = 0.017）;腹主动脉2级以上钙化的发生率为60.2%,髂、股动脉为42.6%,腹主动脉钙化的严重程度显著高于髂、股动脉（χ2 = 8.922,P = 0.003）。X线平片结果表明,腹主动脉钙化发生率为51.9%,髂、股动脉钙化发生率为18.5%。X线平片诊断腹主动脉和髂、股动脉钙化的特异性均为100%,敏感性随MSCT动脉钙化程度的加重而增高。据MSCT钙化评分的不同,其诊断腹主动脉和髂、股动脉钙化的敏感性分别如下：≥1级：60.2%和24.8%;≥2级：76.9%和43.5%;≥3级：100%和74.4%。 结论 X线平片诊断中、重度动脉钙化敏感性高,诊断腹主动脉钙化的敏感度高于髂、股动脉,可用于MHD患者中、重度动脉钙化的检测。     

维持性血液透析患者心血管钙化的发生率及相关因素

目的 探讨维持性血液透析患者心血管钙化的发生率及相关因素.方法 选择接受维持性血液透析≥3月的非住院患者60例,完善相关实验室检查,腹部侧位X线片检测腹主动脉钙化评分(Kauppila法),心脏超声检测心脏瓣膜钙化情况,并计算心血管钙化指数.结果 本组患者影像学检查可见钙化的总发生率为68.3％,腹主动脉钙化的患者中5≤腹主动脉钙化评分＜ 16者占41.4％,瓣膜钙化以主动脉瓣为主(占64.5％).有钙化组与无钙化组患者的年龄、血钙、心血管钙化指数存在差异(均P ＜0.05),而透析龄(月)、身高、体质量、握力、血磷、血红蛋白、血清总蛋白、血清白蛋白、血脂未见差异(均P≥0.05).结论 本组患者心血管钙化部位不均衡,随患者年龄和血钙水平的增加,心血管钙化的发生风险升高.     

腰椎间盘突出症与X线片测量指标的相关性研究

目的探讨单节段腰椎间盘突出症患者腰椎侧位X线片测量指标与腰椎间盘突出程度的相关性。方法回顾性分析自2016-01-2018-12诊治的60例单节段腰椎间盘突出症患者资料,通过腰椎矢状位MRI进行椎间盘退行性改变Pfirrmann分级,在腰椎侧位X线片上测量腰椎曲线指数、腰椎Cobb角、骶骨倾斜角、椎体后缘切线角及椎间隙高度,采用多元线性回归分析Pfirrmann分级与X线片测量指标之间的相关性。结果随着Pfirrmann分级增加,患者腰椎曲线指数、腰椎Cobb角、椎间隙高度逐渐减小,差异有统计学意义(P 0.05)。不同Pfirrmann分级患者的骶骨倾斜角、椎体后缘切线角比较差异无统计学意义(P0.05)。腰椎曲线指数、腰椎Cobb角、椎间隙高度与Pfirrmann分级呈负相关。多元线性回归分析结果显示,腰椎曲线指数(P=0.002)、腰椎Cobb角(P=0.001)、椎间隙高度(P=0.001)是椎间盘退行性改变Pfirrmann分级的独立影响因素。结论临床上测量单节段腰椎间盘突出症患者侧位X线片上腰椎曲线指数、腰椎Cobb角、椎间隙高度对于腰椎间盘突出症诊断具有重要意义。     

护骨素、胎球蛋白A与慢性肾脏病患者腹主动脉钙化的相关研究

目的:探讨慢性肾脏病(CKD)3～5D期患者腹主动脉钙化(AAC)与血清OPG、Fetuin-A的相关性,并分析AAC的危险因素.方法:选取95例CKD3～5D期患者为实验组,同时选取64例健康人作为对照组比较一般临床资料,均采用腹部侧位X线片评估腹主动脉钙化情况,并计算钙化积分;ELISA法检测OPG、Fetuin-...     

维持性血液透析患者血清补体C3水平与腹主动脉钙化的相关性研究

目的探讨维持性血液透析(maintenance hemodialysis, MHD)患者血清补体C3水平与腹主动脉钙化相关性。方法选择2019年2～12月间马鞍山市中医院和马鞍山市中心医院收治的127例MHD患者,根据腹主动脉钙化评分(abdominal aortic calcification score, AACs)将患者分为无钙化组(AACs1分)31例、轻度钙化组(1≤AACs5分)36例、中度钙化组(5≤AACs≤15分)32例、重度钙化组(AACs15分)28例。收集所有患者的临床资料,并检测患者血清补体C3水平,分析血清补体C3水平在不同钙化程度组别患者中的表达差异及其与腹主动脉钙化的相关性,采用Logistic回归分析MHD患者腹主动脉钙化的影响因素,并通过受试者工作特征(receiver operating characteristic, ROC)曲线分析血清补体C3水平对腹主动脉钙化的预测价值。结果轻度钙化组、中度钙化组、重度钙化组患者血磷、全段甲状旁腺素(intact parathyroid hormone, iPTH)、补体C3水平均明显高于无钙化组(P0.05);中度钙化组、重度钙化组患者血磷、iPTH、补体C3水平均明显高于轻度钙化组(P0.05);重度钙化组患者血磷、iPTH、补体C3水平均明显高于中度钙化组(P0.05)。MHD患者血清补体C3水平与血磷、iPTH、AACs评分等均呈显著正相关(P0.05)。血磷、iPTH、补体C3水平等指标为MHD患者腹主动脉钙化的独立危险因素(P0.05)。血清补体C3预测MHD患者腹主动脉钙化的曲线下面积(area under curve, AUC)为0.858(P0.05),具有较高的预测价值。结论血清补体C3水平与MHD患者腹主动脉钙化的严重程度相关,是MHD患者腹主动脉钙化发生的独立危险因素之一,可能成为预测MHD患者腹主动脉钙化发生的重要的生物学标志物。     

腹主动脉钙化评分预测腹膜透析患者心脑血管预后的价值

【目的】 探讨腹主动脉钙化评分(abdominal aortic calcification score,AACS)与腹膜透析患者心脑血管预后的关系。方法 研究对象来自2011年7月至2014年7月期间在上海交通大学医学院附属仁济医院接受规律腹透治疗的患者。采用腹部侧位X线摄片评估所有入选者腹主动脉钙化程度,并根据Kauppila评分系统行AACS评分。根据AACS三分位数将患者分为无钙化组(AACS=0)、轻中度钙化组(0相似文献   

新型支点侧屈位X线片在脊柱侧凸中的应用研究

目的探讨新型支点侧屈位X线片应用于青少年特发性脊柱侧凸选择性胸弯融合中的临床疗效。方法采用自行设计的新型支点侧屈位装置,对我院2013年6月至2014年4月住院的23例青少年特发性脊柱侧凸患者行术前融合节段的选择,其中女性18例,男性5例,平均年龄14.8岁(10.0~19.0岁),13例为Lenke 1AN型;4例为Lenke 1BN型;1例为Lenke 1A-;5例为Lenke 1CN型。影像学评估包括术前站立后前位X线片、新型支点侧屈位X线片以及术后1周、末次随访的站立后前位X线片。测量患者Cobb角,计算该方法比传统方法节省的融合节段。结果术前站立后前位X线片Cobb角平均为(43.7±6.0)°,新型最大支点侧屈位X线片Cobb角平均为(9.2±4.8)°,术后1周站立后前位X线片Cobb角平均为(9.6±3.7)°,末次随访站立后前位X线片Cobb角平均为(10.8±3.7)°。新型最大支点侧屈位X线片平均Cobb角与术后1周站立后前位X线片Cobb角相比差异无统计学意义(t=0.7;P=0.483);术后1周站立后前位X线片平均Cobb角与末次随访的站立后前位X线片平均Cobb角相比差异无统计学意义(t=5.5;P=0.001)。23例AIS患者中17例(74%)患者比传统的Harrington方法节省了至少一个以上融合节段。结论新型支点侧屈位X线片能够安全有效的评估青少年特发性脊柱侧凸融合节段的选择。与传统方法相比较,在青少年特发性脊柱侧凸矫形中应用新型支点侧屈位X线片能够节省融合节段,更多的保留脊柱活动度。     

血液透析患者血管钙化、骨密度与骨保护素及其配体的相互关系

目的 研究维持性血液透析（MHD）患者血管钙化、骨密度与血清骨保护素（OPG）及其配体sRANKL的相互关系。 方法 采用酶联免疫吸附法测定血清OPG、sRANKL水平；X线平片检测腹主动脉、股动脉及桡动脉部位血管钙化，计算血管钙化积分；双能X线骨密度仪测定腰椎及股骨骨密度。对各参数的相互关系进行统计分析。 结果 （1）39例MHD患者中25例（64.1%）在不同部位有不同程度的血管钙化，其中轻度钙化16例（41.0%），中重度钙化9例（23.1%）。中重度钙化者血清OPG水平、OPG/sRANKL比值显著高于轻度钙化者[（342.50±171.53） ng/L比（206.21±137.88） ng/L，t = -2.253，P = 0.025；454.65±455.63比135.31±136.81，t = 59，P = 0.035]，而sRANKL水平差异无统计学意义[（0.10±0.08） pmol/L比(0.12±0.08) pmol/L，t = 0.534，P > 0.05]。多元线性回归分析显示 OPG/sRANKL是血管钙化评分的独立影响因素。（2）与骨量正常者比较，骨量异常者血清OPG水平升高[（249.05±137.66） ng/L比（226.67±170.12） ng/L]，sRANKL水平降低[（0.11±0.08） pmol/L比（0.12±0.02） pmol/L]，OPG/sRANKL比值升高（202.31±219.24比148.08±210.10），但差异均无统计学意义。多元线性回归分析显示OPG/sRANKL是腰椎T值的独立影响因素。（3）多元线性回归分析显示血管钙化评分是腰椎和股骨T值的独立影响因素。 结论 MHD患者血管钙化程度是腰椎及股骨骨密度的独立影响因素， OPG/sRANKL可能在血管钙化和骨密度的关系中起了纽带作用。     

广州地区中老年人症状性膝关节骨关节炎流行病学的调查研究

目的了解广州地区中老年人症状性膝关节骨关节炎(OA)的患病率及其相关因素。方法抽取广州地区具有当地正式户口的40岁及以上居民进行膝关节OA的流行病学问卷调查。对有症状者进行X线拍照,摄取膝关节正侧位片。症状性膝关节OA的最终诊断为最严重节段有膝关节OA临床症状合并影像学KellgrenLawrence分级2级及以上者。结果共分析1339例40岁以上人群资料,症状性膝关节OA总患病率为15.0%,女性多于男性(20.5%vs9.1%,P0.001)。膝关节OA的患病率随年龄增长而升高(P0.001);髌股关节OA的发病率为12.4%,高于周围节段;月经[OR=4.187,95%CI(2.419,7.246)]及跑步[OR=2.689,95%CI(1.018,7.100)]是膝关节OA的好发因素,文职类工作[OR=0.160,95%CI(0.037,0.068)]则为保护性因素。结论调查结果说明广州地区症状性膝关节OA患病率较高,严重影响中老年人生活质量,应当引起重视。     

459例维持性血液透析患者骨密度相关因素的研究

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者跟骨骨密度(bone mineral density,BMD)与透析相关的临床因素及骨代谢、生化指标之间的关系。方法选取2014年6月至2015年2月大连市中心医院MHD患者459例。记录MHD患者性别、年龄、原发病、透析时间、透析治疗方式、使用肝素类型、心血管疾病、主动脉钙化情况。同期检测患者治疗前血钙、血磷、碱性磷酸酶(alkaline phosphatase,ALP)、甲状旁腺素(parathyroid hormone,PTH)、血白蛋白(albumin,Alb)、血红蛋白(hemoglobin,Hb)、碳酸氢根(HCO_3~(2-))水平,计算尿素清除指数(Kt/V)情况。使用美国Sahara超声骨密度仪进行跟骨BMD测量。结果低通量透析患者较高通量透析患者BMD降低(P0.05),有主动脉钙化患者较无主动脉钙化患者BMD降低(P0.01);不同透析时间之间、糖尿病与非糖尿病之间BMD无明显差异。低分子肝素组与普通肝素组BMD比较无明显统计学差异。心血管疾病组与无心血管疾病组之间BMD无统计学差异。血磷及A1b水平与BMD呈正相关(r=0.136,P0.01;r=0.148,P0.01)。女性、年龄≥60岁、低通量透析、有主动脉钙化的患者更易发生骨质疏松,Logistic回归分析显示年龄≥60岁(OR=0.92,95%CI 0.892-0.949)、女性(OR=0.376,95%CI 0.203-0.697)、主动脉钙化(OR=0.01,95%CI:0.000-0.213)是MHD患者骨质疏松的独立危险因素。结论透析治疗方式、血管钙化可能是影响骨密度的因素,血磷和白蛋白水平在骨的生物学功能和骨的矿化过程可能发挥了重要的作用;高龄、女性、主动脉钙化可能是MHD患者骨质疏松的独立危险因素。     

Serum soluble Klotho level is associated with abdominal aortic calcification in patients on maintenance hemodialysis

Objective To determine the relationship between serum soluble Klotho (sKL) level and abdominal aortic calcification in maintenance hemodialysis (MHD) patients. Methods One hundred and twenty nine cases of MHD patients were collected prospectively. Serum sKL was detected by ELISA. Abdomen lateral plain were used as a criteria to determine the abdominal aortic calcification. The abdominal aortic calcification score (AAC) was calculated. Logistic regression analysis was used to determine the risk factor of abdominal aortic calcification in MHD patients. The ROC analysis was applied to evaluate the diagnostic value of sKL in abdominal aortic calcification. Results Eighty-seven patients had abdominal aortic calcification. The median AAC was 4.0 (0.00, 11.00). The median sKL concentration was 616.29 (378.19,821.61) ng/L and the sKL concentration was negatively correlated with AAC (r＝-0.255, P＜0.05). Risk of moderate to severe abdominal aortic calcification in patients with lowest quartile of the sKL concentration was significantly higher than those with highest quartile (OR＝4.004, 95%CI 1.350-11.826, P＜0.05), even after the adjustment for demographic data, lifestyle factors and biochemical markers (OR＝4.542, 95%CI 1.368-15.081, P＜0.05). Multivariate Logistic regression analysis showed that lower serum sKL level and smoking were independent risk factors for severe calcification of the abdominal aorta. ROC-AUC of serum sKL for severe abdominal aortic calcification was 0.746 (cut off 265.39 ng/L, accuracy 88.5%, specificity 56.2%). Conclusions The lower serum sKL is independently associated with severe abdominal aorta calcification. Serum sKL may have diagnostic value for severe abdominal aorta calcification in MHD patients.     

Association of serum FGF23 with abdominal aortic calcification and outcomes in maintenance hemodialysis patients

Objective To explore the association of fibroblast growth factor-23 (FGF23) with abdominal aortic calcification(AAC) and adverse outcomes in maintenance hemodialysis patients. Methods One hundred and fourteen cases of MHD patients were collected prospectively. Serum intact FGF23 was detected by ELISA. Abdomen lateral plain was used as a criteria to determine the abdominal aortic calcification and the abdominal aortic calcification score was counted. Logistic regression analysis was used to determine the risk factors of AAC. Kaplan-Meier analysis was applied to compare the survival rate among different groups and COX regression analysis was used to determine the association of FGF23 and mortality in MHD patients. Results Seventy-six patients present abdominal aortic calcification. The median of AACS was 4.0(0.0, 11.0). The median level of FGF23 was 7277.4(2535.0, 9990.8) pg/ml. The median follow-up duration was 72.0(67.8, 72.8) months. During the follow-up, 22 patients (19.3%) died of all-cause death and 17 cases (14.9%) died of cardiovascular diseases. Serum FGF23 level was positively correlated with AAC (r=0.285, P=0.002). Logistic regression analysis showed that longer age (OR=1.059, 95%CI: 1.020-1.100, P=0.003) and dialysis vintage (OR=1.009, 95%CI 1.000-1.017, P=0.039), smoking history (OR=3.010, 95%CI 1.177-7.696, P=0.021) and higher FGF23 level(OR=2.831, 95%CI 1.010-7.937, P=0.048) were independent risk factors of moderate to severe AAC in MHD patients. Kaplan-Meier survival curves showed that the patients with AACS≥5 had significantly higher all-cause mortality(P=0.028) and CVD mortality (P=0.035) than those with AACS＜5. However, the Kaplan-Meier analysis showed no significant difference regarding the level of serum FGF23 with the all-cause and CVD mortality. Cox regression demonstrated that FGF23 was not associated with increased mortality risk, neither in crude nor in multivariate adjusted models. Conclusions Abdominal aortic calcification had a high prevalence in MHD patients. The all-cause and CVD mortality was higher in patients with moderate to severe AAC. FGF23 was an independent risk factor of moderate to severe AAC, but it can't yet be a predictor for the all-cause and CVD mortality of MHD patients.     

Fibroblast Growth Factor 23 is a Predictor of Aortic Artery Calcification in Maintenance Hemodialysis Patients

Background: Our study aimed to investigate the factors associated with elevated plasma FGF23 (cFGF23) levels in maintenance hemodialysis (MHD) patients and to determine whether plasma FGF23 level is related to aortic artery calcification (AAC). Methods: This study included 120 MHD patients and 20 controls. The FGF23 level was measured using a C-terminal assay and AAC was detected by a lateral lumbar X-ray plain. Results: Plasma FGF23 levels were significantly higher among dialysis patients compared to controls: FGF23 level of 27691.42 ± 55646.41 RU/mL in MHD patients versus 49.89 ± 23.94 RU/mL in health people. Significant correlations were observed between FGF23 levels and vintage, intact parathyroid hormone (iPTH), serum phosphate, total calcium, 25(OH)D, urea nitrogen (BUN), and serum creatinine (SCR). Stepwise multiple regression analysis showed that the independent parameters associated with FGF23 level were serum phosphate, total calcium, parathyroid hormone (PTH), SCR, and prealbumin. There were 73 patients (60.83%) with visible calcification in the abdominal aorta. Bivariate analysis showed that AAC score correlated with FGF23, phosphate, total calcium, vintage, age, and diastolic blood pressure. Forward logistic analysis showed that the independent parameters associated with AAC were age, total protein, and Lg FGF23. Conclusion: Plasma FGF23 level is significant increased in hemodialysis patients and is independently associated with AAC.     

Association between serum soluble Klotho level and outcome in patients on maintenance hemodialysis

Objective To determine the relationship between serum soluble Klotho (sKL) level and adverse outcome in maintenance hemodialysis (MHD) patients. Methods One hundred and twenty nine cases of MHD patients were collected prospectively. Serum sKL was detected by ELISA. Abdomen lateral plain was used as a criterion to determine the abdominal aortic calcification. The abdominal aortic calcification score (AAC) was calculated. Cox regression analysis was used to determine the risk factor of cardiovascular death (CVD) in MHD patients. Kaplan-Meier showed the relationship between sKL and CVD in MHD patients. Results There were 27 cases (20.9%) of all-cause death and 19 cases (14.7%) of cardiovascular death. The median sKL was 612.6(379.2-816.6) ng/L, and log[iPTH] was an independent factor of sKL concentration. Low sKL had high AAC and CVD death rate. Kaplan-Meier method showed that the all-cause death rate was similar between two groups, and CVD death rate increased significantly in low sKL patients (P=0.036). Cox regression indicated that lower sKL level was associated with high CVD death rate [OR=0.352, 95%CI(0.127- 0.977), P=0.045].After adjustment for the general condition, biochemical indicators, the relationship still existed [OR=0.331, 95% CI (0.117-0.933), P=0.037]. In no or mild vascular calcification patients (AAC≤4), compared with high sKL patients, low sKL patients had no significant difference rate in all-cause mortality. The CVD mortality was significantly higher in high sKL (P=0.035) compared with low sKL. In severe calcification group (AAC＞4),all-cause death and CVD death rates were similar between different sKL groups (P=0.991 and 0.522, respectively). Conclusions Lower sKL has the high CVD death rate and sKL level decreasing is an independent risk factor for CVD death in MHD patients. The lower sKL concentration in MHD patients with no or mild calcification may predict CVD mortality. This study suggests that sKL levels may be helpful in predicting the outcome of patients with MHD.     

Risk factors for progression of aortic arch calcification in patients on maintenance hemodialysis

Objective To investigate the possible risk factors for the progression of abdominal aortic calcification (AAC) in MHD patients. Methods Total of 170 patients on MHD between June 2014 and October 2014 in the dialysis center of the Second Hospital of Tianjin Medical University were included prospectively. Lateral lumbar radiography were applied to evaluate patients' AAC score (AACs) at baseline and after two-years of follow-up respectively. According to the change of AACs, the patients were divided into rapid AAC progression group and non-rapid AAC progression group. Multivariable Logistic regression models were used to determine the risk factors for the progression of AAC in MHD patients. Results At baseline, the presence of AAC (AACs≥1) was 43.5%(74/170). The mean follow-up duration was 27.6(24.7, 28.0) months. AACs were available in 111 patients, and the presence of AAC was 78.4%(87/111). During the follow up, 36 patients developed new AAC; rapid AAC progression was seen in 54 patients, and non-rapid AAC progression was seen in 57 patients. Multivariate Logistic regression analysis demonstrated that hyperphosphatemia (OR=4.373,95%CI 1.562-7.246, P=0.005) and high density lipoprotein (HDL) (OR=0.031, 95%CI 0.003-0.338, P=0.004)were independent risk factors for AAC progression in MHD patients. Conclusions Hyperphosphatemia and low HDL may promote the progression of AAC. Well-controlled serum phosphate and lipid metabolism may slow the progression of vascular calcification, reducing cardiovascular morbidity and mortality.     

Conjunctival and corneal calcificationin is associated with abdominal aortic calcification in maintenance haemodialysis patients

Objective To determine the condition of conjunctival and corneal calcificationin in maintenance haemodialysis patients, and explore the relationship between conjunctival and corneal calcificationin (CCC) and abdominal aortic calcification (AAC). Methods CCC was evaluated by slit-lamp eye photographs, and was graded and scored according to Porter’s classification system in the literature. Abdomen 1ateral X-ray examination were used as a criteria to determine the abdominal aortic calcification. The abdominal aortic calcification (AAC) score was calculated. Spearman correlation coefficient was used to analyze the relationship between CCC and AAC. Logistic regression analysis was used to determine the risk factor of CCC in MHD patients. Results Ninety-eight MHD patients were recruited. Their average age and dialysis vintage were (61.89±12.54) years and 51.67 (3.00～192.00) months, ninety-seven patients had conjunctival and corneal calcificationin, and seventy-two patients had abdominal aortic calcification, The median CCC was 8 (0, 17), the median AAC was 6 (0, 20), and the CCC was positively correlated with AAC (r=0.376, P＜0.001). Compared with the patients of CCC score≤5, the patients of CCC score＞10 had a higher level of phosphate, calcium-phosphate product, iPTH, hs-CRP, and longer dialysis vintage, as well as a higher score of AAC (all P＜0.05). Multivariate logistic regression analysis showed that the higher score of AAC and the longer dialysis vintage were independent risk factors for severe corneal calcificationin calcification. Conclusions Conjunctival and corneal calcificationin is common in MHD patients, and CCC is positively associated with AAC, the risk of CCC rises as a result of a severer AAC and a longer dialysis vintage.     

维持性血液透析患者缺血修饰白蛋白水平与腹主动脉钙化相关性分析

目的研究维持性血液透析(maintenance hemodialysis,MHD)患者中缺血修饰白蛋白(ischemia-modified albumin,IMA)水平及其相关因素,并分析IMA与腹主动脉钙化(abdominal aortic calcification,AAC)的关系。方法选取2016年1月至2016年12月在鄂州二医院进行MHD治疗的97例患者作为研究对象。采用白蛋白-钴结合试验测定IMA水平。分析患者各临床指标与IMA的相关性。采用侧位腹部X线片检查对AAC严重程度进行半定量评分,依AAC评分将患者分为无钙化组(19例)、轻度钙化组(26例)、中度钙化组(37例)和重度钙化组(15例),比较各组IMA水平。应用ROC曲线评估IMA水平诊断AAC的特异性和敏感性。结果MHD患者血清IMA水平为83.82(74.30,97.44)U/mL。IMA水平和MHD患者的透析龄(r=0.527,P<0.01)、钙磷乘积(r=0.209,P<0.05)、血清铁(r=0.245,P<0.05)、AAC评分(r=0.649,P<0.01)水平呈正相关;和MHD患者的维生素D(r=-0.218,P<0.05)水平呈负相关。无钙化组、轻度钙化组、中度钙化组和重度钙化组的IMA水平分别为72.04(64.12,76.39)U/mL、82.03(71.96,88.47)U/mL、88.21(81.29,97.36)U/mL、104.07(101.43,125.20)U/mL;组间比较差异有统计学意义(P<0.01)。ROC曲线显示,IMA判断AAC发生的最佳截断值为76.95 U/mL,敏感度为75.6%,特异度为89.5%。结论MHD患者中发生AAC者IMA水平升高,与患者的血管钙化程度、血清铁水平具有相关性,IMA可作为预测AAC发生的有效指标。     

维持性血液透析患者主动脉钙化相关影响因素分析

目的：探讨维持性血液透析（MHD）患者主动脉钙化的相关影响因素。方法：采用胸部正位X线成像技术检测183例MHD患者主动脉钙化情况,将入选患者分为主动脉钙化组（A组）和主动脉无钙化组（B组）,透析前抽血检测血钙、血磷、全段甲状旁腺激素（iPTH）、C反应蛋白（CRP）和血清白蛋白（Alb）等指标,并计算钙磷乘积,比较两组年龄、透析龄和血清学指标的差异,将上述指标与主动脉钙化进行相关性分析,并对筛选出来的危险因素进行非条件Logistic回归分析。结果：A组和B组在年龄、透析龄、血磷、钙磷乘积和CRP水平方面,差异均有统计学意义（P〈0.01或P〈0.05）;MHD患者主动脉钙化的相关影响因素包括：年龄、透析龄、血磷、钙磷乘积及CRP;Logistic回归分析表明,年龄、透析龄和血磷是主动脉钙化的独立危险因素（P〈0.01）。结论：MHD患者主动脉钙化相当常见,主动脉钙化与年龄、透析龄、钙磷代谢和炎症状态有关。     

中晚期CKD患者腹主动脉钙化发生情况及危险因素分析

目的：分析中晚期CKD患者腹主动脉钙化的发生情况和危险因素。方法：63例透析及非透析CKD患者进行腹部侧位片的检查,分析腹主动脉钙化发生情况及影响因素。结果：中晚期CKD患者腹主动脉钙化发生率为54%;腹主动脉钙化与年龄、血磷水平、钙磷乘积和低密度脂蛋白水平呈正相关（P〈0.05）。结论：中晚期CKD患者腹主动脉钙化高发,远端起病,年龄、血脂、钙磷水平影响其程度。     

Relationship between abdominal aortic calcification and outcomes in maintenance hemodialysis patients

Objective To investigate the relationship between abdominal aortic calcification (AAC) and outcomes in maintenance hemodialysis (MHD) patients. Methods One hundred and seventy MHD patients in the dialysis center of the Second Hospital of Tianjin Medical University from June 2014 and October 2014 were enrolled prospectively. Abdominal aortic calcification (AAC) was measured using AAC score (AACS) by abdominal lateral plain radiography. According to the AACS, the patients were divided into mild AAC (AACS＜5) group and severe AAC (AACS≥5) group for comparison, and Kaplan-Meier analysis was used to compare their survival rates. Multivariable COX regression models were used to determine the risk factors of all - cause mortality and cardiovascular disease mortality in MHD patients. Results Severe AAC (AACS≥5) was present in 28.2% (48/170) patients. The median follow-up duration was 25.6 (22.0, 26.0) months. During the follow-up, 6 patients (4.9%) in AACS＜5 group and 14 patients (29.2%) in AACS≥5 group died. Kaplan-Meier analysis showed that patients in AACS≥5 group had higher all-cause mortality rate and cardiovascular disease mortality rate as compared with patients in AACS＜5 group (χ2=9.746,P=0.002; χ2=9.697,P=0.002). Multivariate COX regression analysis demonstrated that high AACS (HR=4.373, 95%CI 1.562-7.246, P=0.005) and hypoproteinemia (HR=0.886, 95% CI 0.797 - 0.985, P=0.025) were independent risk factors for all-cause mortality, while hypoproteinemia (HR=0.829, 95%CI 0.718-0.956, P=0.010) and low 1,25(OH)D3 (HR=0.769, 95% CI 0.627 - 0.944, P=0.012) were independent risk factors for cardiovascular disease mortality. Conclusions AAC is significantly associated with overall survival in MHD patients. To further evaluate the relationship between AAC and outcomes in MHD patients, multi-center and long term follow up studies of large sample size are necessary.