Effects of abdominal aortic calcification progression on outcomes in maintenance hemodialysis patients

Objective To investigate the effects of abdominal aortic calcification (AAC) progression on outcomes in maintenance hemodialysis (MHD) patients. Methods Patients who were on MHD between Jun. 2014 and Oct. 2014 in the dialysis center of the Second Hospital of Tianjin Medical University and finished the AAC examination at baseline and two years later were included prospectively. The progression of AAC by AAC score (AACs) at baseline and two years later was evaluated. According to the change of AACs, the patients were divided into rapid AAC progression group and non-rapid AAC progression group. The effect of AAC progression on outcomes in MHD patients in the follow-up period was investigated. Kaplan-Meier analysis was used to compare their survival rates. Multivariable Cox regression model was used to determine the risk factors of all-cause mortality, cardiovascular mortality and cardiovascular events. Results A total of 111 MHD patients were included, including 51 males and 60 females, aged (52.24±12.69) years. Baseline AAC prevalence was 45.9% (51/111), and median AACs was 0 (0, 5); After 2 years, the prevalence of AAC was 78.4% (87/111), and the median AACs was 6 (2, 11). There were 54 cases in the AAC rapid progression group (AACs change value＞2) and 57 cases in the non-rapid AAC progression group (AACs change value≤2). The median follow-up duration was 27.9(27.1, 28.0) months. Kaplan-Meier analysis showed that patients in rapid AAC progression group had a higher risk of mortality as compared to patients in non-rapid AAC progression group (Log-rank χ2=5.695, P=0.017). Multivariate Cox regression analysis demonstrated that high baseline AACs (HR=1.135, 95%CI 1.001-1.286, P=0.048), hypoalbuminemia (HR=0.789, 95%CI 0.640-0.972, P=0.026) were independent risk factors for all-cause mortality in MHD patients. High baseline AACs (HR=1.187, 95%CI 1.038-1.356, P=0.012), low spKt/V (HR=0.103, 95%CI 0.013-0.801, P=0.030) were independent risk factors for cardiovascular mortality in MHD patients. Low spKt/V (HR=0.018, 95%CI 0.003-0.115, P＜0.001), hypoalbuminemia (HR=0.736, 95%CI 0.608-0.890, P=0.002) were independent risk factors for cardiovascular events in MHD patients. Conclusions Abdominal aortic calcification progression may increase the risk of cardiovascular events and death in MHD patients. Severity of AAC, adequacy of dialysis, and nutritional status are predictors of outcomes 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.     

腹膜透析患者腹主动脉钙化与外周血淋巴细胞亚群的相关研究

目的探讨腹膜透析(peritoneal dialysis,PD)患者腹主动脉钙化(abdominal aortic calcification,AAC)与外周血淋巴细胞亚群之间的关系。方法收集86例PD患者临床资料,腹部侧位平片判断患者发生AAC的程度,并计算腹主动脉钙化积分(AAC score,AACs),依据患者的AACs分为3组:无和轻度钙化组(0≤AACs≤4分)41例、中度钙化组(5≤AACs≤15分)28例及重度钙化组(16≤AACs≤24)17例。利用流式细胞技术分别检测各组患者外周血中淋巴细胞亚群,其中包括CD3⁺、CD3⁺CD4⁺、CD3⁺CD8⁺、CD4⁺/CD8⁺、Treg、CD19⁺、CD16⁺CD56⁺等淋巴细胞的百分率及CD8⁺DR⁺淋巴细胞计数,计算CD4⁺/CD8⁺比值。采用Spearman相关性分析方法分析AAC与外周血淋巴细胞亚群及临床指标的相关性,用Logistic回归分析PD患者发生AAC的危险因素。结果3组患者年龄、原发病为糖尿病肾病、慢性肾小球肾炎以及白蛋白、血磷、碱性磷酸酶水平比较,差异有统计学意义(P<0.05)。Spearman相关性分析结果显示:AAC程度与患者的年龄、透析龄、甲状旁腺素、血磷、碱性磷酸酶、超敏C反应蛋白、CD4⁺/CD8⁺、CD16⁺CD56⁺、CD8⁺DR⁺呈正相关(r=0.352、0.284、0.226、0.299、0.265、0.285、0.236、0.228、0.292,P<0.05),与白蛋白、Treg呈负相关(r=-0.222、-0.354,P<0.05)。Logistic回归模型结果显示:年龄(OR=1.060,95%CI 1.008~1.116,P<0.05),CD4⁺/CD8⁺(OR=25.441,95%CI 1.561~414.659,P<0.05),Treg(OR=0.427,95%CI 0.255~0.715,P<0.05)是PD患者发生腹主动脉中重度钙化的独立预测因素。结论PD患者的AAC程度与外周血中淋巴细胞亚群改变具有相关性。Treg细胞百分率减少、CD4⁺/CD8⁺比值增加可能会加速AAC。PD患者外周血淋巴细胞亚群的改变可能会为AAC的防治提供新方向。     

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.     

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.     

应用腰椎侧位片评价血液透析患者腹主动脉钙化

目的 应用X线平片腹主动脉钙化评分探讨维持性血液透析( MHD)患者腹主动脉钙化患病率和相关危险因素分析.方法 选取我院资料完整的155例MHD患者为研究对象.通过X线腰椎侧位片检测腹主动脉钙化( AAC)并对其进行评分.结果 155例的腰椎侧位片中,腹主动脉钙化主要发生在第4腰椎节段,并随着节段的上升而逐渐减少.63.63％患者的侧位平片上可见腹主动脉钙化;28.39％患者可见严重腹主动脉钙化(钙化累及3个节段以上).MHD患者的年龄(OR=1.094,P＜0.01)、透析龄(OR=1.013,P=0.022)、血三酰甘油(OR=1.261,P=0.030)和血磷(OR=1.324,P=0.023)水平是发生腹主动脉钙化的独立危险因素,而白蛋白(OR=0.239,P=0.013)为保护性因素.结论 MHD患者腹主动脉钙化患病率高,且与多个血管钙化因素相关.半定量的X线腰椎侧位片方法价格便宜、操作简便,易于临床推广.其对MHD患者的预测价值有待日后更多的随访研究.     

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.     

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.     

Assessment and risk factors of abdominal aortic calcification in peritoneal dialysis patients

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.     

Association between serum elastin-derived peptides and abdominal aortic calcification in peritoneal dialysis patients: a cross-sectional study

BackgroundPeritoneal dialysis (PD) patients experience accelerated arterial aging, which is characterized by elastin degradation. Elastin-derived peptides (EDPs) are direct products of elastin fragmentation. This study tried to explore the association between serum EDPs and abdominal aortic calcification (AAC) in PD patients.MethodsSerum levels of EDPs were analyzed in 126 eligible PD patients and 30 controls. PD patients were grouped according to the annularity of AAC evaluated by an abdominal computed tomography (CT) scan. Serum EDPs were analyzed in relation to the presence of AAC or severe AAC in PD patients by logistic regression analysis.ResultsSerum EDPs in PD patients were significantly higher than age-matched controls. In 126 PD patients, higher EDPs was associated with greater risk of present AAC (OR = 1.056, 95%CI 1.010–1.103) and severe AAC (OR = 1.062, 95%CI 1.004–1.123). A combination of EDPs substantially improved the accuracy of diagnostic performance for AAC and severe AAC.ConclusionsEDPs can predict the presence and extent of AAC in PD patients, indicating its possible role to recognize PD patients at risk for AAC and severe AAC.     

Incidence of cognitive impairment and risk factors associated with prognosis in maintenance hemodialysis patients

Objective To investigate the incidence and prognosis of cognitive impairment and to find out the risk factors associated with the outcome for better understanding and preventing cognitive impairment in maintenance hemodialysis (MHD) patients. Methods The patients who met the criteria as below: MHD patients (≥3 months) in Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2000 to July 2014, ≥18 years old were enrolled and could carry on the montreal cognitive assessment (MoCA) of voluntary cooperation. According to the score of MoCA, all enrolled patients were divided into two groups: cognitive impairment (MoCA＜26) group and non-cognitive impairment (MoCA≥26) group. The follow-up period was 3 years. There were 130 males, and the incidence, demography data, medical history, hemodialysis data, laboratory examination and prognosis of cognitive impairment in hemodialysis patients were prospectively compared and analyzed. Logistic regression analysis was used to investigate the risk factors of cognitive impairment. Kaplan-Meier survival curve and Cox regression model were used for prognostic analysis. Results A total of 219 MHD patients were enrolled. The incidence of cognitive impairment in MHD patients was 51.6%. There were 130 males, and the ratio of male to female was 1.46∶1. Age was (60.07±12.44) years old and dialysis vintage was (100.79±70.23) months. Compared with non-cognitive impairment group (n=106), patients in cognitive impairment group (n=113) were older, and had higher proportion of education status＜12 years, history of diabetes and anuria (all P＜0.05); however, the post-dialysis systolic pressure, pre-dialysis diastolic pressure, post-dialysis diastolic pressure, platelet and spKt/V were lower (all P＜0.05). Multivariate logistic regression analysis showed that education status＜12 years (OR=3.428, 95%CI 1.919-6.125, P＜0.001), post-dialysis diastolic pressure＜73 mmHg (OR=2.234, 95%CI 1.253-3.984, P=0.006) and spKt/V＜1.72(OR=1.982, 95%CI 1.102-3.564, P=0.022) were the independent risk factors for cognitive impairment in MHD patients. The Kaplan-Meier survival curve analysis showed that the survival rate of patients with cognitive impairment was lower than that of non-cognitive impairment group in MHD patients during 3 years follow-up (χ2=3.977, P=0.046). Multivariate Cox regression analysis showed that cognitive impairment was an independent risk factor for death in MHD patients (RR=2.661, 95%CI 0.967-7.321, P=0.058). Conclusions Cognitive impairment is one of the common complications and an independent risk factor for death in MHD patients. The mortality is high in patients who suffer cognitive impairment. Education status ＜12 years, post-dialysis diastolic pressure＜73 mmHg and spKt/V＜1.72 are the independent risk factors for cognitive impairment in MHD patients.     

Investigation of vascular access in maintenance hemodialysis patients in Shanxi province

Objective To understand the current situation of vascular access selection in maintenance hemodialysis (MHD) patients in Shanxi Province, and analyze the factors affecting vascular access selection and risk factors of death in MHD patients. Methods MHD patients with clear vascular access information in Shanxi Province from January 2014 to December 2018 were enrolled in this study. The clinical data of patients were collected. The vascular access information of the selected candidates was clear. Multivariate logistic regression equation method was used to analyze the influencing factors of vascular access and the risk factors of death in MHD patients. Results Among the 10.236 patients with MHD, 9.130 patients (89.2%) selected autologous arteriovenous fistula (AVF) as vascular access, and 5.138 patients (50.2%) chose tunnel-free and non-polyester sheath central venous catheter (NCC) for the first dialysis. Multivariate logistic regression analysis showed that the primary disease of diabetic nephropathy (OR=0.517, 95%CI 0.281-0.796, P＜0.001) and dialysis age＜1 year (OR=0.483, 95%CI 0.219-0.811, P＜0.001) were the influencing factors of patients with MHD who did not to choose AVF. Primary disease of diabetic nephropathy (OR=2.242, 95% CI 1.816-2.828, P＜0.001), and using of central vein catheter (OR=1.785, 95% CI 1.237-2.579, P＜0.001) were independent risk factors of death in MHD patients. Conclusions AVF is the first choice for MHD patients in Shanxi Province. There is higher proportion of the use of NCC as the first dialysis vascular access. Primary disease of diabetic nephropathy and dialysis age＜1 year are the influencing factors for MHD patients not to choose AVF. Primary disease of diabetic nephropathy and use of central vein catheter may increase the risk of death in MHD patients.     

维持性血液透析患者主动脉瓣和二尖瓣钙化的危险因素

目的 探讨主动脉瓣和二尖瓣钙化发病的相关危险因素。 方法 对符合标准的维持性血液透析（MHD）患者（年龄≥18岁,透析龄>6个月,排除曾因瓣膜疾病行外科手术或介入治疗者）,采用超声心动图检查心脏瓣膜钙化情况。采用Logisitc回归分析主动脉瓣和二尖瓣钙化的危险因素。 结果 在入选的181例（男98例,女83例）MHD患者中,94例（51.9%）主动脉瓣或二尖瓣钙化,其中主动脉瓣钙化90例（49.7%）,二尖瓣钙化30例（16.6%）,主动脉瓣和二尖瓣双瓣膜钙化26例（14.4%）。多因素Logistic回归分析表明年龄（β = 5.52, P = 0.007）、透析龄（β = 6.99,P = 0.039）和前白蛋白（β = -12.616,P = 0.004）与主动脉瓣钙化独立相关;年龄（β = 0.085,P = 0.05）与二尖瓣钙化呈弱正相关;透析龄（β = 6.057,P = 0.002）、原发性高血压病病史（β = 3.054,P = 0.008）、血红蛋白（β = -0.061,P = 0.035）和β2微球蛋白（β = 7.63,P = 0.01）与二尖瓣钙化独立相关。 结论 MHD患者主动脉瓣及二尖瓣钙化多发,且以主动脉瓣钙化更多见。年龄、透析龄和低前白蛋白血症是主动脉瓣钙化的危险因素,而二尖瓣钙化的危险因素包括年龄、透析龄、原发性高血压病病史、贫血和高β2微球蛋白血症。     

骨硬化蛋白与维持性血液透析患者冠状动脉钙化的关系

Objective To evaluate the potential association of serum sclerostin with the development of coronary artery calcifications(CAC)in maintenance hemodialysis (MHD) patients. Methods Ninety-two patients who were on MHD between Jan 2014 and Jan 2015 in the dialysis center were enrolled prospectively. Serum sclerostin was tested. CAC was measured by multi-slice computed tomography (MSCT) scanning, and the CAC score (CACs) was calculated. Logistic regression analysis was used to determine the risk factor of CAC in MHD patients. The diagnostic value of serum sclerostin for CAC was assessed using receiver operator characteristic curve (ROC). Results CAC (Agatston score>100) was present in 65.2% (60/92) patients, the median CAC score was 446 (26, 1 000). The median of serum sclerostin levels was 37.05 (29.99, 49.04) ng/L. The serum sclerostin levels were significantly elevated in the group of CACs＞400 compared to that in the group of CACs＜100 [40.71(36.69, 74.21) ng/L vs 28.16 (25.27, 33.64) ng/L, P＜0.05]. Multivariate logistic regression analysis showed that serum sclerostin level was independent risk factor for CAC (OR=1.292, 95%CI 1.017-1.641, P＜0.05). The area under the ROC curve (AUC) of serum sclerostin for CAC was 0.846 (95%CI 0.717-0.975, P=0.001), sensitivity was 0.826, and specificity was 0.769 for a cutoff value of 35.165 ng/L. Conclusions Serum sclerostin level is associated with CAC. Serum sclerostin level may have a diagnostic value for CAC in MHD patients.     

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。     

Relationship between coronary artery calcification and outcomes in maintenance hemodialysis patients

Objective To evaluate the relationship between coronary artery calcification (CAC) and outcomes in maintenance hemodialysis (MHD) patients. Methods Eighty-six patients who were on MHD between October 2014 and May 2015 in the blood purification center of our hospital were enrolled prospectively. CAC was measured and scored by multiple slice computed tomography (MSCT). According to the CAC score (CACs), the patients were divided into mild CAC (CACs＜100) group and severe CAC (CACs≥100) group. Kaplan-Meier analysis was performed to analyze the survival rates of the two groups, and a COX proportional hazards regression model was used to estimate the risk factors of all-cause mortality and cardiovascular disease mortality in MHD patients. Results Severe CAC (CACs≥100) was present in 62.8% (54/86) patients. The median of follow-up duration was 28.9(23.8, 29.4) months. During the follow up, 2(6.3%) patients in CACs＜100 group and 18 (33.3%) patients in CACs≥100 group died. Kaplan-Meier survival analysis demonstrated that patients in CACs≥100 group had higher all-cause mortality and cardiovascular mortality as compared with patients in CACs＜100 group (P=0.007, P=0.030). Multivariate COX regression analysis demonstrated that CACs≥100 (HR=7.687, 95%CI 1.697-34.819, P=0.008) and low single-pool Kt/V (HR=0.092, 95%CI 0.020-0.421, P=0.002) were independent risk factors for all-cause mortality. Old age (HR=1.192, 95%CI 1.100-1.291, P＜0.001), short duration of dialysis (HR=0.598, 95%CI 0.445-0.804, P=0.001), low 25-hydroxy vitamin D3 (HR=0.461, 95%CI 0.326-0.630, P＜0.001), and low total cholesterol (HR=0.405, 95%CI 0.213-0.772, P=0.006) were independent risk factors for cardiovascular disease mortality. Conclusions The CACs is significantly related with overall survival in MHD patients. Large multicenter prospective studies are to be evaluated the association between CACs and long-term survival in MHD patients.     

Multicenter study on the influencing factors of interdialysis blood pressure variability in maintenance hemodialysis patients

Objective To assess the influencing factors of interdialysis blood pressure variability (BPV) in maintenance hemodialysis (MHD) patients from Pearl River Delta, and provide clinically useful information for the prevention and treatment of BPV. Methods MHD patients in 10 hemodialysis centers from Pearl River Delta were enrolled and analyzed retrospectively. According to the quartile of interdialysis systolic blood pressure-coefficient of variation (SBP-CV), patients were divided into four groups, and clinical data, biochemical indicators and drug use were compared among 4 groups. Binary logistic regression analysis was used to analyze the associated factors of interdialysis BPV. Results A total of 1010 MHD patients (612 males and 398 females) with the age of (56.3±13.9) years were enrolled in this study. Their dialysis duration was (48.4±36.1) months, and the median of interdialysis SBP-CV was 8.07% (5.72%, 11.34%). According to the quartile of SBP-CV, the patients were divided into four groups: low BPV group (SBP-CV≤5.72%, 253 cases), middle BPV group (5.72%＜SBP-CV≤8.07%, 252 cases), high BPV group (8.07%＜SBP-CV≤11.34%, 253 cases) and extremely high BPV group (SBP-CV＞11.34%, 252 cases), and the dialysis duration, diabetes, ultrafiltration, interdialysis weight gain rate (IDWGR), serum calcium and the proportion of calcium channel antagonist used in the 4 groups were significantly different (all P＜0.05). Logistic multiple regression analysis showed that high IDWGR (OR=1.216, 95%CI 1.108-1.435, P＜0.001) was an independent risk factors for interdialysis BPV in MHD patients, while high ultrafiltration volume (OR=0.436, 95%CI 0.330-0.575, P＜0.001) and calcium channel antagonists used (OR=0.686, 95%CI 0.477-0.986, P=0.042) were independent protective factors. Conclusion High IDWGR is an independent risk factor for interdialysis BPV in MHD patients, while high ultrafiltration volume and calcium channel antagonists used are protective factors for interdialysis BPV in MHD patients.     

眼科住院患者医院感染情况及相关危险因素

目的探讨眼科住院患者医院感染发生情况及危险因素,并提出预防控制措施。 方法2013年1月至2014年12月选取828例眼科住院患者为研究对象,根据患者是否发生医院感染分为感染组（52例）及非感染组（776例）,采用单因素及Logistic多因素分析筛选眼科住院患者医院感染的相关危险因素。 结果眼科住院患者医院感染发生率为6.28%（52/828）,感染部位主要为切口感染3.38%（28/828）。经单因素分析显示,年龄> 60岁、夏季住院、手术时间、住院时间≥ 14 d、多人病房、侵入性操作、接触性检查、术前未应用抗菌药物、合并糖尿病、Ⅱ类切口及操作者资料< 3年与眼科住院患者术后感染有关。经Logistic多因素分析显示,患者年龄> 60岁（OR = 2.995,95%CI：1.406～6.383）、住院时间≥ 14 d（OR = 3.102,95%CI：1.267～7.597）、合并糖尿病（OR = 3.494,95%CI：1.948～6.266）、术前未应用抗菌药物（OR = 4.768,95%CI：2.233～10.181）、侵入性操作（OR = 5.652,95%CI：2.197～14.537）以及接触性检查（OR = 6.135,95%CI：2.919～12.895）是眼科住院患者医院感染的独立危险因素。 结论眼科住院患者医院感染发生率较高,临床应严格规范无菌操作,加强对老年、合并糖尿病等高危人群管理,术前科学合理应用抗菌药物,尽量缩短患者住院时间有助于降低眼科住院患者医院感染的发生率。     

Incidence of maintenance hemodialysis patients with fatigue and its related factors

Objective To investigate the incidence of fatigue in maintenance hemodialysis (MHD) patients and its related factors. Methods A total of 289 patients on MHD between January 2016 and March 2017 in hemodialysis centers of the First Affiliated Hospital of Xinjiang Medical University, Xinjiang Yili Kazak Autonomous Prefecture Friendship Hospital, and Yili Prefecture Hospital were enrolled. Internationally standard fatigue rating scale (FAI) was applied to assess the incidence of fatigue in MHD patients, and subjective comprehensive nutrition assessment (SGA) protein energy wasting rating scale was used to assess protein energy wasting (PEW) conditions. All patients were divided into the fatigue group and the non-fatigue group according to the FAI score. The clinical data and the blood biochemical indicators in two groups were compared. The risk factors of fatigue in MHD patients were analyzed by logistic regression method. Results The incidence of fatigue was 83.0% in MHD patients, and the rate of PEW was 62.6%. Blood total cholesterol in the fatigue group was lower than that of the non-fatigue group (P＜0.05). The difference between SGA scores of two groups had statistical significance (P＜0.001). Single factor logistic regression analysis results showed that higher SGA score (OR=1.312, 95%CI: 1.163-1.481, P＜0.001), lower blood total cholesterol (OR=0.661, 95%CI: 0.496-0.880, P=0.005) were risk factors of fatigue in MHD patients. Multivariable logistic regression analysis results showed that higher SGA score (OR=5.286, 95%CI: 2.078-13.442, P＜0.001) was an independent risk factor of fatigue in MHD patients. Conclusions The incidence of fatigue and PEW are high in MHD patients. PEW is an independent risk factor of fatigue in MHD patients.     

Quantitative assessment of abdominal aortic calcification and associations with lumbar intervertebral disc height loss: the Framingham Study

Background contextVascular disease has been proposed as a risk factor for disc height loss (DHL).PurposeTo examine the relationship between quantitative measures of abdominal aortic calcifications (AACs) as a marker of vascular disease, and DHL, on computed tomography (CT).Study designCross-sectional study in a community-based population.Patient sampleFour hundred thirty-five participants from the Framingham Heart Study.Outcome measuresQuantitative AAC scores assessed by CT were grouped as tertiles of “no” (reference), “low,” and “high” calcification. Disc height loss was evaluated on CT reformations using a four-grade scale. For analytic purposes, DHL was dichotomized as moderate DHL of at least one level at L2–S1 versus less than moderate or no DHL.MethodsWe examined the association of AAC and DHL using logistic regression before and after adjusting for cardiovascular risk factors and before and after adjusting for age, sex, and body mass index (BMI).ResultsIn crude analyses, low AAC (odds ratio [OR], 2.05 [1.27–3.30]; p=.003) and high AAC (OR, 2.24 [1.38–3.62]; p=.001) were strongly associated with DHL, when compared with the reference group of no AAC. Diabetes, hypercholesterolemia, hypertension, and smoking were not associated with DHL and did not attenuate the observed relationship between AAC and DHL. Adjustment for age, sex, and BMI markedly attenuated the associations between DHL and low AAC (OR, 1.20 [0.69–2.09]; p=.51) and high AAC (OR, 0.74 [0.36–1.53]; p=.42).ConclusionsAbdominal aortic calcification was associated with DHL in this community-based population. This relationship was independent of cardiovascular risk factors. However, the association of AAC with DHL was explained by the effects of age, sex, and BMI.