腰椎侧位X线片评估维持性血液透析患者腹主动脉钙化的研究

目的:探讨腰椎侧位X线片评估维持性血液透析患者腹主动脉钙化(AAC)的意义,分析AAC与心血管疾病发生的关系。方法:选择34例维持性血液透析(MHD)患者,检测肝、肾功能和电解质等指标;利用腰椎侧位X线片评估AAC积分。分析AAC的发生率、分布特点和严重程度;比较钙化组与非钙化组患者心血管疾病(CVD)发生情况;以受试者操作特征曲线(ROC曲线)下面积评价AAC积分对诊断MHD患者发生CVD的特异性。结果:34例MHD患者中,28例发生AAC(占82.4%);钙化发生率从腰椎L1向L4逐渐增高(P0.05),且钙化程度逐步加重(P0.05)。与非钙化组比较,钙化组患者CVD的发生率显著增高(71.4%vs 33.3%,P0.05);发生CVD患者的AAC积分显著高于未发生CVD的患者(P0.05);AAC积分显示发生CVD的ROC曲线下面积为0.738。结论:MHD的AAC的发生率较高,钙化程度由L1向L4逐步加重;AAC积分可用于预测MHD发生CVD的可能性。

Study on lateral lumbar spine radiograph in evaluating abdominal aortic calcification in patients with maintenance hemodialysis

Objective： To investigate the significance of lateral lumbar spine radiograph in evaluating abdominal aortic calcification （ACC） in patients with maintenance hemodialysis （MHD） , and to analysis the relationship between AAC and cardiovascular disease. Methods： Liver, renal function, blood serum electrolytes and other parameters were detected in 34 patients with MHD. The lateral lumbar spine radiograph was used to evaluate AAC scores. The incidence of AAC, feature of distribution and severity as well as the correlations of clinical various parameters in patients with AAC were analyzed. The oc- currence of cardiovascular diseases in patients with aortic calcification and non-calcified group was compared. The area under receiver operating characteristic （ROC） curves was used for evaluating the accuracy of AAC scores in diagnosis of CVD in hemodialysis patients. Results： Among 34 cases with MHD, the incidence of AAC was 82.4% （28 cases）. The incidence and degree of aortic calcification increased from L1 to L4 level （ P 〈 0.05 ）. The calcification group of patients had significantly increased incidence of CVD as compared with non-calcified group （71.43% vs 33.33% , P 〈0.05）. AAC scores of patients with CVD were significantly higher than those patients without CVD （ P 〈 0.05 ） . The area under the ROC curve was 0. 738 that AAC scores diagnosed the occurrence of CVD. Conclusions： The incidence of AAC is higher in patients with MHD. AAC gradually aggravates from L1 to L4 lumbar level. AAC scores can be used to predict the incidence of CVD in patients with MHD.