规律血液透析患者甲状旁腺激素水平对腹主动脉钙化的效应分析

目的探讨维持性血液透析(MHD)患者腹主动脉钙化(AAC)的相关危险因素。方法通过X线腹部侧位片对177例MHD患者进行AAC评分,按腹主动脉钙化有无将患者分为钙化组和非钙化组,比较两组患者的人口学特征、透析龄、心血管事件、高血压病史、高脂血症病史、糖尿病病史、碳酸钙及活性维生素D用药史以及血钙、血磷、全段甲状旁腺激素(i PTH)、高敏C反应蛋白(hs-CRP)等实验室指标的不同,通过Logistic回归分析AAC发生的相关危险因素,并比较不同PTH水平组患者AAC的发生率。结果 177例MHD患者中58.2%(103例)存在腹主动脉钙化,钙化组患者心血管事件的发生率显著高于非钙化组(33.3%vs 9.4%,P=0.001)。单因素分析显示钙化组患者高龄、长透析龄、高hs-CRP、高脂血症、高血压、碳酸钙用药史、活性维生素D用药史人数显著高于非钙化组,差异有统计学意义(P0.005)。Logistic回归分析显示:高龄、高脂血症、高血压、长透析龄、高i PTH、高hs-CRP、活性维生素D和碳酸钙用药史是AAC的危险因素。随着血清i PTH水平的增高,AAC的发生率也随之增加,即使在矫正了年龄、性别、吸烟、透析龄、高血压、糖尿病、高hs-CRP、活性维生素D用药史、碳酸钙用药史等影响因素后,这种作用依然存在。结论 MHD患者腹主动脉钙化发生率明显高于正常人群。研究发现年龄、高脂血症、高血压、透析龄、高PTH、高hs-CRP、活性维生素D和碳酸钙用药史是AAC的危险因素,其中高i PTH水平是MHD患者AAC的独立危险因素。     

老年营养风险指数联合血清补体C3水平在维持性血液透析患者腹主动脉钙化评估中的价值

目的 探讨老年营养风险指数(GNRI)联合血清补体C3水平在维持性血液透析(MHD)患者腹主动脉钙化(AAC)评估中的价值.方法 选取232例MHD患者,根据是否合并AAC分为钙化组(n=165)与无钙化组(n=67),根据AAC评分将钙化组分为重度钙化组(n=48)、中度钙化组(n=55)、轻度钙化组(n=62).收...     

高骨钙蛋白浓度降低腹主动脉钙化进展

腹主动脉钙化指数（AAC）是2型糖尿病等以胰岛素抵抗为特征的疾病的心血管风险的一个指标。AAC是成骨细胞分泌的一种可以增加胰岛素敏感性和胰岛素分泌的激素。为了确定老年人基线水平血清总骨钙蛋白与AAC进展及10年全因死亡率的关系，研究结果表明，     

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。     

维持性腹膜透析患者血清微小核糖核酸-29b表达水平与腹主动脉钙化的相关性研究

目的:探讨维持性腹膜透析患者血清微小核糖核酸(miR)-29b水平与腹主动脉钙化相关性.方法:选取2017年7月至2020年7月,在我院行维持性腹膜透析治疗的患者176例,收集临床资料,行腹部侧位X线片检查并采用半定量积分法评估腹主动脉钙化积分(AACS),根据AACS积分将患者分为非钙化组和钙化组,利用实时荧光定量P...     

血清SIRT6、FBLN1水平与腹膜透析患者腹主动脉钙化的关系

目的 探讨患者血清沉默信息调节因子6(SIRT6)、腓骨蛋白1(FBLN1)水平与腹膜透析（PD）患者腹主动脉钙化（AAC）的关系。方法 选取132例PD患者为PD组,同期另选取46名健康体检者为对照组。采用酶联免疫吸附法检测两组血清SIRT6、FBLN1;收集PD患者病历资料;根据AAC积分将PD患者分为AAC组53例、非AAC组79例。用Spearman相关法分析AAC患者血清SIRT6、FBLN1水平与AAC积分的相关性;用多因素Logistic回归分析PD患者AAC的影响因素;用受试者工作特征（ROC）曲线分析血清SIRT6、FBLN1水平对PD患者AAC的评估价值。结果 PD组血清SIRT6水平低于对照组,FBLN1水平高于对照组（P均<0.05）。Spearman相关法分析显示,AAC患者AAC积分与血清SIRT6水平呈负相关,与FBLN1水平呈正相关（rs分别为-0.793、0.796,P均<0.05）。透析龄延长和全段甲状旁腺素、FBLN1升高为PD患者AAC的独立危险因素,SIRT6升高为独立保护因素（P均<0.05）。ROC曲线分析显示,血清SIR...     

社区人群体质指数与高血压及高血脂患病率的关系

目的了解广州市开发区夏港社区人群体质指数（BMI）与高血压厦高血脂的关系。方法采取分层抽样方法，利用2004年广州市社区诊断个人健康情况调查表，入户面对面问卷及告知居民体检注意事项到医院统一体检的方法。并对不同人群的体重、血压、血脂进行分析。结果肥胖组与体重过低组、正常组，超重组与正常组高血压患病率间差异均有显著性意义（P〈0．05）。同时，不同体质指数调查对象TG、LDL-C、HDL—C间差异均有显著性意义（P〈0．05）。结论BMI水平与高血压和高血脂密切相关，超重和肥胖是高血压和血脂异常的危险因素。对本社区居民如何进行有效的健康教育，改变不良的生活方式，降低高血压厦血脂异常的患病率有重要意义。     

维持性血液透析患者心血管钙化的发生率及分布特点

目的:探讨维持性血液透析(MHD)患者心血管钙化分布及相关因素。方法:选择MHD≥3月的患者144例,完善相关实验室检查,螺旋CT检测冠状动脉钙化评分(CACS,Agaston法),腹部侧位平片检测腹主动脉钙化评分(AACS,Kauppila法),心脏超声检测心脏瓣膜钙化情况,计算心血管钙化指数(CCI)。结果:本组患者影像学可见钙化的总发生率为70.83%,29.17%无钙化,普遍钙化者26.39%,选择性钙化者44.44%。冠脉钙化的患者中,CACS100的患者占50.67%,腹主动脉钙化的患者,AACS5者占48.48%,瓣膜钙化以二尖瓣为主(34.25%)。钙化总发生率无性别差异,随年龄和透析龄的增长而增加。AACS与CACS呈正相关(r=0.636),发生瓣膜钙化的患者CACS更高(P0.00 1)。比较普遍钙化与无钙化的患者,年龄、透析龄、体质量指数、腹围、踝臂指数、总胆固醇、低密度脂蛋白、超敏C反应蛋白、是否糖尿病存在差异(P0.05),而收缩压、舒张压、血钙、血磷、全段甲状旁腺激素、磷结合剂和活性维生素D的用药情况未见差异(P≥0.05)。高龄、高血钙、贫血、血脂异常是冠脉钙化的独立危险因素;高龄、血脂异常是腹主动脉钙化的独立危险因素;高龄和长透析龄是心脏瓣膜钙化的独立危险因素。CCI与CACS比较有良好的特异度和灵敏度。结论:本组患者心血管钙化部位不均衡,年龄、透析龄、血钙、血脂及部分传统心血管危险因素与钙化的发生有关。CCI可能是更优质的血管钙化评价指标。     

老年钙化性主动脉瓣膜病的超声诊断

<正>随着人们年龄的增长,身体各系统的机能逐渐退化,从而产生各种老年退化性疾病。老年钙化行瓣膜病是老年性退化性瓣膜病中最为常见的类型,发病率随人们年龄的增大而上升〔1〕。主要是由于患者年龄的增长,其机体的钙盐逐渐在瓣膜     

Body mass index is inversely related to mortality in older people after adjustment for waist circumference

OBJECTIVES: To examine the individual and combined influence of body mass index (BMI) and waist circumference (WC) on mortality risk in older people. DESIGN: Longitudinal cohort study. SETTING: Cardiovascular Health Study, a longitudinal study of cardiovascular disease and its risk factors in older people. PARTICIPANTS: Five thousand two hundred men and women aged 65 and older. MEASUREMENTS: BMI and WC were measured at baseline. The risks of all-cause mortality associated with BMI and WC were examined using Cox proportional hazards models over 9 years of follow-up. RESULTS: When examined individually, BMI and WC were both negative predictors of mortality, but when BMI and WC were examined simultaneously, BMI was a negative predictor of mortality, whereas WC was a positive predictor of mortality. After controlling for WC, mortality risk decreased 21% for every standard deviation increase in BMI. After controlling for BMI, mortality risk increased 13% for every standard deviation increase in WC. The patterns of associations were consistent by sex, age, and disease status. CONCLUSION: Higher BMI values indicated a lower mortality risk once the risk attributable to WC was accounted for, whereas higher WC values indicate a higher mortality risk once the risk attributable to BMI was accounted for. Both BMI and WC should be measured in the clinical setting, but in older adults higher BMI is associated with lower mortality rates.     

Central and peripheral fat mass have contrasting effect on the progression of aortic calcification in postmenopausal women.

AIM: To investigate the long-term effects of central fat mass (CFM) and peripheral fat mass (PFM) on atherogenic risk profile and the progression of aortic calcification (AC) in postmenopausal women. METHODS AND RESULTS: Participants were 316 women aged 50-76 years, who were followed for 7.7 years. CFM and PFM were measured at baseline by DXA and related to follow-up measures of atherogenic metabolites, blood pressure, and the progression of AC assessed on lateral radiographs. CFM and PFM independently of each other exhibited contrasting influence on follow-up measures of atherogenic risk factors and the progression of AC. In a multiple regression model, the negative contribution of PFM (P<0.05), but not the adverse contribution of CFM, was independent of confounders. When comparing different extreme forms of obesity, women with central obesity showed the greatest (2.36+/-0.60, n=11), whereas those with peripheral obesity the smallest changes in AC (0.50+/-0.34, n=10) over the study period. Women with general obesity also tended to show less progression of AC compared with women with central obesity (1.23+/-0.42, n=21). CONCLUSIONS: This study provides direct support for the independent anti-atherogenic influence of PFM and calls on further research to define the adipocyte-derived factors involved in this favourable effect.     

Abdominal aortic calcification is associated with Fibrosis‐4 index and low body mass index in type 2 diabetes patients: A retrospective cross‐sectional study

Aims/IntroductionThis study aimed to clarify the nature of the relationship between the abdominal aortic calcification (AAC) grade and the presence of cardiovascular diseases, and determine factors related to AAC grade in people with type 2 diabetes mellitus.Materials and MethodsThis retrospective cross‐sectional study enrolled 264 inpatients with type 2 diabetes mellitus. The AAC score and length were measured using the lateral abdominal radiographs. Logistic regression models were used to assess the associations between AAC scores/lengths and the presence of coronary artery disease (CAD), cerebral infarction (CI) and peripheral artery disease (PAD). The correlation between AAC scores/lengths and other clinical factors were evaluated using linear regression models.ResultsThe AAC score was significantly correlated with prevalent CAD and CI independent of age and smoking, but not with the prevalence of PAD. AAC length was not significantly correlated with the presence of CAD, CI or PAD; however, the sample size was insufficient to conclude, probably due to low prevalence. Both the AAC score and length were correlated inversely with body mass index (BMI) and, with the Fibrosis‐4 (Fib‐4) index >2.67; these correlations were significant after adjusting for cardiovascular risk factors and BMI, although AAC was not associated with ultrasonography‐diagnosed fatty liver. There was a significant interaction between BMI and Fib‐4 index; lower BMI and Fib‐4 index >2.67 showed a synergistic association with high AAC grade.ConclusionsAAC score is associated with CAD and CI morbidity in participants with type 2 diabetes mellitus. Low BMI and Fib‐4 index >2.67 can be valuable indicators of AAC in people with type 2 diabetes mellitus.     

Body mass index in adults with congenital heart disease

Objective: To investigate the status of body mass index (BMI) in adult people with congenital heart disease (ACHD).
Methods: Five hundred thirty‐nine adults with CHD (53.8% men) were seen in the outpatient clinic from 2013 to 2015 and compared to a reference population (n = 1737). The severity of CHD was categorized as mild, moderate, and severe ac‐ cording to standard guidelines. Patients were categorized based on BMI as under‐ weight (<18.5), overweight (25‐30), or obese (>30). Echocardiography and magnetic resonance imaging were used to measure ventricular function while exercise capac‐ ity was estimated via cardiopulmonary exercise test.
Results: Adults with CHD had slightly lower BMI than the reference group (24.1 ± 4.3 vs 24.6 ± 4.3; P = .012). Men in the mild and severe group (23.9 ± 3.6; 23.3 ± 4.4 vs 25.1 ± 3.7; P = .007; P = .023) and women in the severe group (21.6 ± 3.3 vs 24.2 ± 4.7; P < .001) had lower BMI compared to the reference group. In the subgroups, men with ventricular septal defect, coarctation of aorta/ventricular septal defect and Fontan cir‐ culation and women with Fontan circulation had lower BMI than the reference group. Underweight was more prevalent in women with severe lesions compared to the refer‐ ence group (22.2% vs 3.8%; P < .001). BMI was associated with age and exercise ca‐ pacity in patients with mild and moderate lesions, while higher BMI was related to better ventricular function in women with Fontan circulation.
Conclusion: Underweight was more prevalent in ACHD patients with severe lesions. Special attention should be paid to the possible existence of underweight‐related comorbidities.     

Osteoprotegerin,inflammation and dyslipidemia are associated with abdominal aortic calcification in non-diabetic patients on peritoneal dialysis

Background and aimsAbdominal aortic calcification (AC) has been reported to be associated with cardiovascular disease (CVD) in hemodialysis patients but is rarely discussed in peritoneal dialysis (PD) patients. We examined the independent predictors and predictive power for survival of AC in prevalent PD patients.Methods and ResultsAC was detected by computed tomography (CT) and represented as the percentage of the total aortic cross-section area affected by AC (%AC). The predictors of %AC ≥15 were examined by multiple logistic regression analysis. Cox proportional hazard analysis was used to determine the hazard ratios associated with high %AC. A total of 183 PD patients were recruited to receive CT scans and divided into group 1 (%AC < 15, n = 97), group 2 (%AC ≥ 15, n = 41), and group 3 (diabetic patients, n = 45). Group 1 patients had lower osteoprotegerin (OPG) levels than group 2 patients (798 ± 378 vs. 1308 ± 1350 pg/mL, p < 0.05). The independent predictors for %AC ≥ 15 included the atherogenic index, OPG, and C-reactive protein (CRP). The age-adjusted hazard ratios associated with %AC ≥15 were 3.46 (p = 0.043) for mortality and 1.90 (p = 0.007) for hospitalization.Conclusions%AC can predict mortality and morbidity in non-diabetic PD patients, and 15% is a good cut-off value for such predictions. There are complex associations among mineral metabolism, inflammation, and dyslipidemia in the pathogenesis of AC.     

二瓣化畸形加速主动脉瓣钙化的机制研究进展

主动脉二瓣化畸形是最常见的先天性主动脉瓣发育异常,发病率约0.5%-2%,易并发主动脉瓣钙化、主动脉夹层、主动脉瘤等疾病。几乎所有的该类患者在成年期后都会出现主动脉瓣钙化,且发病年龄比三瓣化主动脉瓣者提前20年。为何二瓣化畸形容易出现主动脉瓣钙化加速,其机制仍存在许多争议。目前研究认为目前研究认为异常的遗传学表达、血流动力学、炎症反应及内皮功能障碍之间的相互作用可能是重要原因,本综述将从以上几个方面对其进行讨论。