X线平片钙化积分预测维持性血液透析患者冠状动脉钙化的研究

目的探讨不同部位X线平片钙化积分对维持性血液透析（MHD）患者冠状动脉钙化的预测价值。方法选择四川省人民医院血液透析中心MHD患者36例,行多层螺旋CT、X线平片（包括骨盆正位、侧腹位、双手正位）,以多层螺旋CT作为评价冠状动脉钙化的金标准,应用受试者工作曲线（ROC）比较不同X线平片钙化积分对冠状动脉钙化积分（CACs）≥100的预测价值。结果比较CACs〈100组与CACs≥100组,2组在年龄、透析前舒张压、心血管不良事件差异有统计学意义（P〈0.05）,余均无统计学意义的差异。骨盆正位X线平片钙化积分的ROC曲线下面积（AUC）最大且有统计学意义（P=0.002）,其它部位X线平片钙化积分对CACs≥100的预测能力无统计学意义,当骨盆正位X线平片钙化积分〉0、〉1、〉2、〉3时,其敏感性和特异性分别为95.65%和53.85%、73.91%和61.54%、56.52%和92.31%、47.83%和92.31%。结论 X线平片钙化积分可以预测MHD患者冠状动脉钙化,可以选择骨盆正位X线平片进行初步筛查,骨盆正位X线平片钙化积分〉2时应高度怀疑MHD患者存在100的冠状动脉钙化积分。

Assessment of coronary artery calcification in maintenance hemodialysis patients using X-ray plain

Objective The purpose of the present study was to utilize a simple method,X-ray plain and its different combination models,to assess coronary artery calcification in maintenance hemodialysis（MHD） patients.Methods We selected thirty-six patients from our hemodialysis center.The golden criteria of coronary artery calcification evaluation was multi-slice spiral computed tomography.Each patient did multi-slice spiral computed tomography,and X-ray plain（including Pelvis AP,lateral projection of lumbar vertebrae and hands AP X-Ray plain）.Receiver operating curve（ROC） was used to evaluate the predictive power of various X-ray assessment methods.Results Compared to CACs100 group,patients in CACs≥100 group had higher age,lower pre-dialysis diastolic blood pressure,and often had a history of cardiovascular events.Comparing the predictive power of different combination models of CACs≥100,the four score model of pelvis was as well as other models which had P〈0.05,but the former with an area under ROC Curve of 0.811 was the highest.The sensitivity and specificity for calcification score of Pelvis AP X-rays0,1,2,3were 95.65% and 53.85%,73.91% and 61.54%,56.52% and 92.31%,47.83% and 92.31%,respectively.Conclusion Plain X-rays can be first preformed to assess vascular calcification in MHD patients.Pelvis AP X-rays is the best assessment method for coronary artery calcification assessment.MHD Patient whose calcification score of Pelvis AP X-rays≥2 is predicted to have CACs≥100.