施行复杂的胸廓内-冠状动脉手术时的重要解剖、生理问题

作者在20个月中,连续作692例冠状动脉搭桥手术,其中87%的病例作1支或数支胸廓内动脉(IMA)吻合。一侧 IMA 搭桥469例(占68%)。双侧 IMA 130例(19%)。采用大隐静脉者93例(13%)。平均吻合3.5支(全组)。57例再次手术,其中双侧 IMA 移植13例(23%)。3支或多支吻合60例:3支 IMA 50例,4支IMA 吻合9例,6支 IMA 1例。27例于术后30天内再作冠状动脉造影,评价 IMA、大隐静脉和自身冠状动脉血流的动力学改变。通过移植血管到自身冠状血管的主要血流:原位 IMA 为62%,游离 IMA 为86%,大隐静脉为94%。住院死亡率1.7%(11/635),不包括再次手术者,单侧 IMA 移植(4/437)或双侧 IMA(1/117)的死亡率均低于1%。可是单用大隐静脉作移植的住院死亡率竟高达7.4%(6/81)。通过原位 IMA     

肠系膜下动脉低位结扎及根部淋巴结廓清在腹腔镜低位前切除手术中的临床意义

目的:探讨腹腔镜低位前切除(low anterior resection,LAR)术中行肠系膜下动脉(inferior mesenteric artery,IMA)低位结扎及根部淋巴结廓清的临床意义。方法:2011年10月至2013年10月为114例直肠癌患者行腹腔镜LAR,随机分为对照组(n=55)与观察组(n=59)。观察组采用IMA低位结扎及根部淋巴结廓清;对照组采用IMA高位结扎术及根部淋巴结廓清。对比分析手术时间、淋巴结清扫数量、吻合口漏发生率及术后首次通气时间。结果:手术时间、淋巴结清扫数量、吻合口漏发生率两组差异无统计学意义(P>0.05);术后首次通气时间观察组少于对照组,差异有统计学意义(P<0.05)。结论:LAR术中行IMA低位结扎及根部淋巴结廓清优于IMA高位结扎术及根部淋巴结廓清,具有推广应用的价值。     

正常足与踇外翻足第一序列的测量及其临床意义

目的探讨踇外翻的病理、发病机制、分型以及手术方式的选择。方法对正常足245足和踇外翻足141足进行以下参数的测量和统计学分析踇外翻角(HVA)、跖间角(IMA)、趾间角(IPA)、近侧关节固角(PASA)、远侧关节固角(DASA)、跖楔角(MCA)。结果踇外翻组PASA、MCA均大于正常组,IPA却小于正常组,而两组DASA比较差异无显著性意义。两组均可见随着HVA的增大,IPA减小。踇外翻组可见(1)随着HVA的增大,PASA有增大的趋势,而IMA无明显的变化规律;(2)IMA增大者,MCA也增大,差异具有统计学意义,而HVA与MCA无统计学的联系。结论踇外翻的病理因素包括IPA、PASA及IMA。踇外翻可分为六型Ⅰ型,IPA增大为主,IPA≥22°,而PASA、IMA均在正常值范围内;Ⅱ型,单纯HVA增大,HVA≥20°,而IPA、IMA、PASA均在正常值范围内;Ⅲ型,以PASA增大为主,IMA可以正常或轻度增大,PASA≥11°,而IMA≤15°;Ⅳ型,以IMA增大为主,其又可分为两个亚型,Ⅳa型,10°≤IMA≤15°,Ⅳb型,IMA>15°,而PASA在正常值范围内;Ⅴ型,混合型,IMA>15°,PASA≥11°;Ⅵ型,跖趾骨关节炎型。每一型各有不同的发病机制,应采用不同的手术方式。     

直肠癌肠系膜下动脉根部淋巴结转移规律的研究

目的 研究直肠癌肠系膜下动脉(inferior mesenteric artery,IMA)根部淋巴结的转移规律,探讨IMA根部淋巴结清扫在直肠癌根治术中的意义.方法 回顾性分析北京大学第一医院2005-2008年间接受直肠癌手术并进行IMA根部淋巴结清扫的105例直肠癌患者的临床病理资料,对IMA根部淋巴结转移的影响因素进行单因素及多因素分析,并与同期收治的未行IMA根部淋巴结清扫的204例直肠癌患者的术后5年生存率及局部复发率进行比较.结果 IMA根部淋巴结转移率为9.5％ (10/105),淋巴结有转移患者的5年生存率(20.0％,2/10)明显低于无转移者(76.9％,70/91)(x2=21.546,P＜0.05).多因素分析显示肿瘤浸润深度(Wald=5.764,P＜0.05)为pT3、pT4,分化程度为低分化、未分化的直肠癌患者(Wald =7.818,P＜0.05),IMA根部淋巴结转移率明显增高.IMA根部淋巴结清扫与否的5年生存率分别为71.3％(72/101)和70.6％(142/201),差异无统计学意义(x2=0.000,P=0.995);局部复发率分别为1.9％ (2/105)和7.4％ (15/204),差异有统计学意义(x2=3.958,P＜0.05).结论 肠系膜下动脉根部淋巴结清扫并不能提高直肠癌患者的5年生存率,但是可以降低局部复发率;对于肿瘤浸润深度为T3、T4,分化程度为低分化、未分化的直肠癌,肠系膜下动脉根部淋巴结清扫降低了局部复发率.     

跖骨远端Chevron截骨结合关节囊松解治疗轻、中度拇外翻

目的探讨跖骨远端Chevron截骨结合关节囊松解治疗轻、中度拇外翻的临床效果。方法对32例患者(48足)行Chevron截骨手术治疗,测量手术前后拇趾外翻角(HVA),第1、2跖骨间夹角(IMA)的变化,评估足部疼痛及关节活动恢复情况。结果 29例(44足)获得随访,时间12~16(14.5±4.1)个月;3例(4足)失访。患者对术后临床效果满意,截骨部位愈合时间为4~6周。术前HVA为30°±4.1°、IMA为14°±1.7°;术后3个月HVA为4°±4.2°、IMA为10°±2.4°,术后1年HVA为5°±4.5°、IMA为11°±3.3°,均较术前明显减小,差异有统计学意义(P0.05);术后1年与术后3个月的HVA、IMA比较差异无统计学意义(P0.05)。结论跖骨远端Chevron截骨结合关节囊松解治疗轻、中度拇外翻疗效满意。     

头侧中间入路的腹腔镜直肠癌根治术

我们尝试采用头侧中间入路法以解决目前传统中间入路的一些不足。手术具体步骤包括:推开屈氏韧带处的空肠,切断该处附着的筋膜及韧带,将小肠肠袢完全推至右上腹部,显露屈氏韧带和左侧结肠系膜、腹主动脉及肠系膜下血管;从肠系膜下动脉(IMA)头侧的腹主动脉表面腹膜处打开进入左结肠后间隙,并顺势清扫IMA根部周围巴结;打开IMA尾侧的直乙结肠系膜并进入乙结肠后间隙,清扫IMA下方的周围淋巴结,并使乙结肠后间隙和左结肠后间隙贯通;显露IMA,肠系膜下静脉(IMV)和左结肠血管、乙结肠血管等相关血管,用血管夹夹闭离断相关血管根部,并可选择性的保留左结肠血管等。后续步骤同传统中间入路腹腔镜直肠癌根治术。     

右美托咪啶对合并高血压的手外伤手术患者血压、MDA、IMA的影响

目的探讨右美托咪啶对合并高血压的手外伤手术患者血压、丙二醛(MDA)、血浆缺血修饰蛋白(IMA)的影响。方法选取2016年3月至2017年8月在本院诊断的78例合并高血压的手外伤手术患者,采用随机数字表法分为对照组和观察组,各39例。观察组给予臂丛神经阻滞麻醉联合术中持续泵入右美托咪啶,对照组给予臂丛神经阻滞麻醉联合术中持续泵入生理盐水。对比两组患者麻醉阻滞时间,比较两组患者舒张压(DBP)、收缩压(SBP)、MDA和IMA水平。结果实施臂丛神经阻滞后,观察组运动阻滞、感觉阻滞维持时间明显高于对照组(P0.05);观察组的SBP和DBP水平明显低于对照组(P0.05);释放止血带后10分钟(T_1~′)时,两组的IMA和MDA水平明显高于臂丛神经阻滞前(T_0~′)时(P0.05),但观察组的IMA和MDA水平明显低于对照组(P0.05)。结论持续泵入右美托咪啶,能增强合并高血压的手外伤手术患者术中麻醉效果,同时能有效抑制围麻醉期异常的血压增高、降低IMA和MDA水平。     

肠系膜下动脉根部结扎在直肠癌前切除术中的应用

目的 探讨肠系膜下动脉(IMA)根部结扎对直肠癌根治术的临床应用价值.方法 将2003年1月至2007年12月收治的173例直肠癌前切除术患者随机分成两组,其中根部结扎组85例,采用IMA根部结扎术及根部淋巴结廓清,非根部结扎组88例,采用IMA低位结扎及结扎部位淋巴结廓清.根部结扎组,比较两组患者的平均手术时间、淋巴结数及转移度、复发率、5年生存率、并发症发生率.结果 非根部结扎组的淋巴结数、淋巴结转移度、术后生存率明显低于根部结扎组,复发率则明显高于根部结扎组(P＜0.05);两组手术时间、并发症比较,差异无统计学意义(P＞0.05).结论 IMA根部结扎及根部淋巴结廓清对直肠癌的治疗效果优于IMA非根部结扎及结扎部位淋巴结廓清,值得推广应用.     

直肠癌肠系膜下动脉根部淋巴结转移的预测模型构建及准确性验证

目的构建直肠癌肠系膜下动脉(IMA)根部淋巴结转移的预测模型并验证其准确性。方法回顾性分析2014年1月至2019年3月行直肠癌手术的156例患者资料,所有患者均行IMA根部淋巴结清扫。统计分析采用SPSS 20.0软件,对与IMA根部淋巴结转移相关的临床病理因素进行单因素分析(采用χ^2检验)及多因素Logistic回归分析。并构建IMA根部淋巴结转移的预测模型,通过描绘受试者工作特征曲线(ROC)并计算曲线下面积(AUC)从而来评估模型的预测能力,P<0.05表示差异具有统计学意义。并以术后病理诊断结果为金标准对预测模型进行验证。结果在156例患者中,IMA根部淋巴结转移21例,转移率为13.5%;平均每例送检淋巴结为2.3个(1~9个),共送检淋巴结359个,其中有转移的淋巴结有72个,转移度为20.1%。多因素回归分析结果显示,肿瘤大小、pT分期、分化程度、是否有肝转移及术前血清CEA水平是IMA根部淋巴结转移的独立危险因素。根据Logistic回归分析各变量的回归系数构建预测模型,通过绘制ROC曲线,计算出AUC值为0.856(95%CI 0.825~0.886),当最佳临界值为2.49时对IMA根部淋巴结转移具有预测价值,此时该预测模型的灵敏度为90.21%,特异度为86.20%,约登指数为0.56。以术后病理诊断为金标准,验证预测模型,灵敏度为85.71%,特异度为99.26%,两者灵敏度和特异度差异无统计学意义(P>0.05)。结论基于Logistic多因素回归分析建立预测模型具有较高的灵敏度和特异性,对直肠癌肠系膜下动脉根部淋巴结转移的患者具有较高的预测价值,为临床实践提供一定的理论支撑。     

肠系膜下动脉低位结扎并血管根部淋巴结清扫术治疗直肠癌临床价值研究

目的 探讨肠系膜下动脉(IMA)低位结扎(LL)并血管根部淋巴结清扫术对直肠癌患者的临床应用价值。方法 回顾性分析2019-02—2022-03新密市中医院(西院区)普外二科行腹腔镜全直肠系膜切除术(TME)治疗的86例直肠癌患者的临床资料。按手术方案分为2组，各43例。B组实施IMA高位结扎(HL),A组实施IMA LL。比较2组患者的基线资料。统计围术期指标，评价手术前后肛门失禁Wexner评分，检测手术前后胃动素(MTL)、胃泌素(GAS)胃肠功能水平，统计术后并发症发生率。结果 2组患者的基线资料、术中失血量、淋巴结清扫数目、手术时间差异均无统计学意义(P>0.05)。A组患者术后肛门恢复排气时间短于B组，术后第7天、14天、28天的肛门失禁Wexner评分优于B组。差异均有统计学意义(P<0.05)。术后第7天时A组患者的血清MTL、GAS水平较高于B组，并发症总发生率低于B组，差异均有统计学意义(P<0.05)。结论 与IMA HL并血管根部淋巴结清扫术比较，IMA LL并血管根部淋巴结清扫术治疗直肠癌患者，有助于缩短患者术后肛门恢复排气时间、减少并发症发...     

Fibroblast Growth Factor 23 is a Predictor of Aortic Artery Calcification in Maintenance Hemodialysis Patients

Background: Our study aimed to investigate the factors associated with elevated plasma FGF23 (cFGF23) levels in maintenance hemodialysis (MHD) patients and to determine whether plasma FGF23 level is related to aortic artery calcification (AAC). Methods: This study included 120 MHD patients and 20 controls. The FGF23 level was measured using a C-terminal assay and AAC was detected by a lateral lumbar X-ray plain. Results: Plasma FGF23 levels were significantly higher among dialysis patients compared to controls: FGF23 level of 27691.42 ± 55646.41 RU/mL in MHD patients versus 49.89 ± 23.94 RU/mL in health people. Significant correlations were observed between FGF23 levels and vintage, intact parathyroid hormone (iPTH), serum phosphate, total calcium, 25(OH)D, urea nitrogen (BUN), and serum creatinine (SCR). Stepwise multiple regression analysis showed that the independent parameters associated with FGF23 level were serum phosphate, total calcium, parathyroid hormone (PTH), SCR, and prealbumin. There were 73 patients (60.83%) with visible calcification in the abdominal aorta. Bivariate analysis showed that AAC score correlated with FGF23, phosphate, total calcium, vintage, age, and diastolic blood pressure. Forward logistic analysis showed that the independent parameters associated with AAC were age, total protein, and Lg FGF23. Conclusion: Plasma FGF23 level is significant increased in hemodialysis patients and is independently associated with AAC.     

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.     

慢性肾衰竭患者血清骨保护素浓度与心脏瓣膜钙化的关系

目的探讨慢性肾衰竭（CRF）患者血清骨保护素（OPG）水平与心脏瓣膜钙化的关系。方法以75例CRF患者[非透析组（ND）25例,腹透组（PD）28例,血透组（HD）22例1和10例健康人（对照组）为研究对象,采用酶联免疫复合物法测定患者血清OPG水平,分析其与心脏瓣膜钙化之间的关系。结果各组CRF患者血清中OPG水平[ND组（4.77±1.74）μg/L、PD组（5.22±1.57）μg/L、HD组（5.35±1.72）μg/L]显著高于对照组[（2.04±0.57）μg/L,P〈0.01]。OPG水平与年龄（r=0.311,P〈0.05）和C反应蛋白水平（r=0.353,P〈0.01）呈正相关。根据有无心脏瓣膜钙化分组后发现,存在瓣膜钙化的CRF患者OPG水平较无瓣膜钙化组显著升高[（6.28±1.66）μg/L比（4.59±1.40）μg/L,P〈0.01]。Logistic回归分析显示血清OPG水平是CRF患者心脏瓣膜钙化发生的一项独立危险因素（P〈0.01）。结论在CRF患者中,血清OPG水平与心脏瓣膜钙化相关。     

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...     

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.     

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.     

成纤维细胞生长因子23与慢性肾脏病中晚期患者冠状动脉钙化的关系

目的 探讨慢性肾脏病（CKD）中晚期患者血成纤维细胞生长因子23（FGF23）水平与冠状动脉钙化的关系。 方法 2010年4月至12月我院肾脏科病房、腹透中心、血透中心的CKD非透析（CKD 3~5期）、腹膜透析和血液透析患者共150例为对象;年龄、性别匹配的25例健康体检者为对照。收集患者临床和相关生化指标资料。采用酶联免疫法测定血清全段FGF23水平。对入选患者进行冠脉多层螺旋CT（MSCT）检查。分析FGF23水平与CKD中晚期患者冠脉钙化的关系。 结果 CKD中晚期患者血清FGF23水平显著高于健康对照组[196.46（83.09,355.02） ng/L比27.17（21.63,51.20） ng/L,P < 0.01];透析患者的FGF23水平显著高于非透析患者（P < 0.01）;血透患者的FGF23水平显著高于腹透患者[6048.29 （1129.08,34807.45） ng/L比1625.80（602.83,7521.78） ng/L,P < 0.01]。CKD中晚期患者冠脉钙化发生率较高（74/130,56.9%）,血清FGF23水平与冠脉钙化分数（CaS）呈正相关（r = 0.177,P < 0.05）。Logistic回归分析显示年龄（β = 0.091,OR = 1.095,P < 0.01）、透析龄（β = 2.013,OR = 7.483,P < 0.05）和FGF23水平（β = 0.838,OR = 2.311,P < 0.05）是CKD中晚期患者发生冠脉钙化的独立危险因素。冠状动脉钙化的ROC曲线显示,FGF23曲线下面积为0.705（P < 0.01）,当检测的截点为786.73 ng/L时,其敏感度和特异性分别为62.5%和75.9%;碱性磷酸酶（AKP）的曲线下面积为0.626（P = 0.017）,当检测的截点为79.75 U/L时,其敏感度和特异性分别为84.5%和41.5%。血磷在诊断冠脉钙化时没有统计学意义。 结论 血清FGF23水平与CKD中晚期患者冠脉钙化发生相关。FGF23作为诊断冠脉钙化的参考指标,其敏感度低于AKP,特异性优于AKP。     

Relationship between serum magnesium level and coronary artery calcification in maintenance hemodialysis patients

Objective To evaluate the relationship between serum magnesium and coronary artery calcification (CAC) and their associated factors. Methods 131 patients with chronic kidney disease on regular hemodialysis (HD) were recruited into this study from December 2014 to December 2015 in our center. Demographic and clinical data of selected patients were collected. Serum fibroblast growth factor 23 (FGF-23) level was quantified by enzyme linked immunosorbent assay(ELISA). Quantification of coronary artery calcification score (CACs) was determined by multi-slice spiral computed tomography (MSCT). The relationships between serum magnesium and FGF-23 level, CACs, demographic and clinical data were investigated. Results Patients were divided into low serum magnesium group, normal serum magnesium group and high serum magnesium group according to their serum magnesium levels. There were significant differences in the distribution of diabetes history, serum phosphorus, serum albumin, serum pre albumin, serum uric acid among these three groups(P＜0.05). A significant positive correlation was confirmed between serum magnesium level and serum albumin, serum pre albumin, serum phosphorus and serum uric acid by Pearson correlation analysis and Spearman correlation analysis (r=0.389, 0.234, 0.200, 0.234, P=0.000, 0.007, 0.022, 0.007, respectively). According to the degree of CAC, all maintenance hemodialysis (MHD) patients were divided into non-calcification group, low calcification group, moderate calcification group and high calcification group, and there were significant differences in the distribution of the age, serum phosphorus, serum magnesium, FGF-23 levels among these groups (P＜0.05) . Spearman correlation analysis showed that CACs was positively correlated with age, FGF-23, serum phosphorus (r=0.309, 0.277, 0.180, P=0.000, 0.001, 0.040, respectively), while negatively correlated with serum magnesium level (r=-0.238, P=0.006) in patients with MHD. The independent risk factors of CACs were aging, high level of FGF-23 in MHD patients by using ordinal logistic regression. However, Hypermagnesemia was a protective factor. Conclusions The history of diabetes, low serum albumin, phosphorus metabolism disorder and CAC are associated with hypomagnesemia in MHD patients. In MHD patients, aging as well as high level of FGF-23 are the risk factors of CAC, and hypermagnesemia is a protective factor of CAC.     

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.