血透患者冠状动脉钙化多层螺旋CT评价及与心血管事件的关系

目的 通过对血液透析患者进行多层螺旋CT冠状动脉钙化评分,分析其与心血管事件发生的关系.方法 29例初始血液透析患者(透析龄<6个月)接受冠状动脉多层螺旋CT钙化评价及相关因素检测,随访评价心血管事件;随访时间为18个月.结果 所有29例患者多层螺旋CT冠状动脉扫描:62.07%(18/29)的患者存在冠状动脉钙化,平均钙化积分为482.41±739.97;18个月随访期内,发生心血管事件23例次,其中冠状动脉钙化组22例次,无冠状动脉钙化组仅1例次(P=0.001);心血管事件发生与冠状动脉钙化相关(Spearman's Rho=0.882,P<0.0005);多元逐步回归分析表明,冠状动脉钙化与年龄和高血磷有关(P=0.013,P=0.043),其中,C反应蛋白、血钙、全段甲状旁腺激素、胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、体重指数、收缩压、舒张压未能进入回归方程(P>0.05);随访期内,因心血管事件死亡6例,占15.79%,其中冠状动脉钙化组5例,无冠状动脉钙化组1例;Kaplan-Meier生存分析显示,无心血管事件生存率两组无统计学差异(P=0.2150).结论 血液透析患者冠状动脉钙化多层螺旋CT评分有助于心血管事件发生危险度的评价.

The Evaluation of Coronary Artery Calcification by Multislice Spiral CT Scan in Hemodialysis Patients and Its Association with Cardiovascular Events

Aim To evaluate coronary artery calcification(CAC) by multislice spiral CT scan in patients starting to undergo hemodialysis,and to analyse its association with cardiovascular events in the follow-up. Methods 29 patients starting to undergo chronic hemodialysis(duration of hemodialysis under 6 months) were enrolled in this study.CAC score,along with related parameters,was quantified by Multislice Spiral CT scan at the initiation of this study.The patients were followed up for about 18 months for appraising cardiovascular events. Results 18 cases of CAC(62.07%) were identified by CT scan in 29 patients starting to undergo chronic hemodialysis,with average CAC score being 482.41±739.97.During the 18 months follow-up,significant difference of cardiovascular events was documented among patients with CAC(22 times) and without CAC(1 time)(P=0.001).CAC was independently associated with cardiovascular events(Spearman''s Rho=0.882,P<0.0005).Stepwise regression analysis in 29 patients indicated that CAC score was related with age and serum PO4(P=0.013,P=0.043).However,CRP,Ca,iPTH,Chol,TG,HDL-C,LDL-C,BMI,SBP and DBP were excluded from this regression equation(P>0.05). 6 cases(15.79%) were died of cardiovascular events during the 18 months follow-up,including 5 cases with CAC and 1 case without CAC.Kaplan-Meier survival analysis showed that there was no significant difference between patients with CAC and without CAC(P=0.2930). Conclusion Multislice Spiral CT based coronary artery calcification scoring is helpful in risk evaluation of cardiovascular events of hemodialysis patients.