腹膜透析患者心脏瓣膜钙化的临床研究

 目的 探讨持续性非卧床腹膜透析(Continuous ambulapory peritoneal dialysis,CAPD)患者心脏瓣膜钙化的危险因素,降低CAPD患者心血管疾病发生率.方法 将54例CAPD患者根据透析时间长短及心脏瓣膜钙化程度分组,观察心脏瓣膜钙化与血钙、血磷、白蛋白等各生化指标的关系.结果 腹膜透析患者中存在不同程度心脏瓣膜钙化,随着透析时间的延长,瓣膜钙化率增加(P＜0.01);钙化组血磷、钙磷乘积、甲状旁腺激素较无钙化组显著增高,而白蛋白较无钙化组显著降低(P＜0.05或P＜0.01).结论 腹膜透析患者心脏瓣膜钙化程度与营养状态及透析时间密切相关,患者高磷血症及钙磷乘积升高是心脏瓣膜钙化的重要危险因素.     

腹膜透析患者钙磷代谢紊乱的相关研究

 目的 探讨腹膜透析(CAPD)患者钙磷代谢平衡的调节及肾性骨病的防治.方法 所有患者化验血钙、血磷、肌酐、甲状旁腺素等生化指标,而后根据不同的残余肾功能、钙磷乘积值、透析液日交换剂量、透析时间长短分组.结果 腹膜透析患者普遍存在钙磷代谢紊乱,钙磷乘积升高组血磷、甲状旁腺素值高,透析时间长(P＜0.05);随透析剂量增加血磷、血肌酐值下降(P＜0.05);残余肾多的患者血磷、钙磷乘积值降低(P＜0.05).结论 腹膜透析患者普遍存在钙磷代谢紊乱,以钙磷乘积及血磷升高为突出表现.残余肾功能对于血磷的清除起重要作用.     

腹膜透析患者下肢动脉病变与钙磷代谢紊乱的相关性

目的 观察应用不同钙离子浓度透析液治疗的腹膜透析患者下肢动脉病变与钙磷代谢紊乱的关系,探讨持续性非卧床腹膜透析（continuous ambulatory peritoneal dialysis,CAPD）患者下肢动脉病变的危险因素.方法 根据使用不同钙离子浓度腹膜透析液,将54例CAPD患者分组,A组27例使用PD-2标准钙腹透液（Ca2＋ 1.75 mmol/L）;B组27例使用PD-4低钙透析液（Ca2＋ 1.25 mmol/L）.两组均持续透析1年以上,观察组间下肢动脉狭窄与血钙、血磷等各生化指标的关系.结果 54例不同钙离子浓度透析患者,1年后下肢动脉狭窄者数量均有升高,A组高于B组,组间差异有统计学意义（P＜0.05）.治疗1年后两组间：血色素、胆固醇值差异无统计学意义（P＞0.05）;血钙值、血磷值、甲状旁腺素值及下肢动脉内中膜厚度值间差异有统计学意义（P＜0.05）.下肢动脉病变程度与血磷水平正相关（P＜0.05）,与血清iPTH水平、Hb水平负相关（P＜0.05）,与血钙、血脂、肌酐值不存在相关性（P＞0.05）.结论 下肢动脉狭窄程度在不同钙离子浓度腹膜透析患者中不相同,其动脉狭窄程度与钙磷代谢紊乱相关,是下肢动脉狭窄的重要危险因素.     

腹膜透析患者微炎症状态的相关研究

目的观察腹膜透析(CAPD)患者超敏C-反应蛋白(hs-CRP)、白介素-6(IL-6)以及肿瘤坏死因子-α(TNF-α)等相关指标的表达,探讨炎症因子对腹膜透析患者的影响。方法选择74例CAPD患者分别送检hs-CRP、IL-6、TNF-α,同时测定肌酐(Cre)、血钙(Ca)、血磷(P)、血红蛋白(Hb)、胆固醇(Chol)、三酰甘油(TG)、白蛋白(Alb)。根据主观综合性营养评估法(SGA)计算分值,观察腹膜透析患者炎症因子与各生化指标的关系。结果腹膜透析患者血清炎症因子(hs-CRP、IL-6、TNF-α)水平均显著高于正常对照组(P<0.01)。CRP>5 mg/L组血清IL-6和TNF-α水平均显著高于CRP<5 mg/L组;血清Hb、Alb水平及SGA均显著低于CRP<5 mg/L组,两组比较,差异均有统计学意义(P<0.01)。而两组Ca、P、Chol和Cre水平比较,差异无统计学意义(P>0.05);腹膜高转运患者血清hs-CRP及IL-6水平高于其他各组,组间差异有统计学意义(P<0.01)。结论腹膜透析患者存在微炎症状态,腹膜高转运功能患者炎症因子升高明显,炎症与低蛋白血症、营养状态差等因素密切相关。     

腹膜透析患者成纤维细胞生长因子23与股动脉内中膜厚度的相关性

 目的 探讨腹膜透析患者成纤维细胞生长因子23(fibroblast growth factor -23,FGF-23)与股动脉内中膜厚度(intima-media thickness,IMT)的关系。方法 将82例持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者根据股动脉壁最大内膜厚度不同分组,观察CAPD患者组间FGF-23与IMT的关系。结果 CAPD患者中股动脉IMT增厚的检出率为45.12%,IMT增厚组患者的年龄、血磷、糖化血红蛋白、甲状旁腺激素、FGF-23水平明显高于IMT正常组,差异具有统计学意义(P＜0.05),以患者IMT值作为因变量进行多元回归分析,结果显示CAPD患者的血磷、iPTH、FGF-23与患者股动脉IMT增厚独立相关(P＜0.05)。结论 FGF-23是慢性肾衰竭(chronic kidney disease, CKD)患者钙磷代谢紊乱、血管钙化等事件的重要生物标志物,是CAPD患者血管钙化的早期重要预警指标。     

低钙透析联合小剂量骨化三醇在血透患者中的应用

目的：探讨维持性血透患者在骨化三醇小剂量治疗继发性甲状旁腺功能亢进同时应用低钙透析液进行透析的安全性和有效性。方法：选择维持性血透患者共59例,合并继发性甲状旁腺功能亢进,用小剂量骨化三醇（罗盖全）口服治疗,每次0.25-0.5μg,1/d,于每晚睡前服用;碳酸钙（钙尔奇）每次1500mg,1/d,午饭时服用。透析采用稀释后浓度为1.25mmol/L的碳酸低钙透析液,观察透析前后血钙、血磷、钙磷乘积和PTH。结果：3个月后血钙维持正常水平,无显著性差异,血磷明显下降,有显著性差异（P〈0.01）,钙磷乘积明显下降,有显著性差异（P〈0.01）,PTH明显下降,有显著性差异（P〈0.01）。结论：维持性血透合并继发性甲状旁腺功能亢进的患者,在口服小剂量骨化三醇（罗盖全）治疗过程中,应用低钙透析液进行透析,可以有效避免高钙血症及转移性钙化的出现,同时有效降低血磷、钙磷乘积,血清甲状旁腺激素水平。     

持续性非卧床腹膜透析对颈动脉中膜厚度的影响

 目的 探讨持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)对颈动脉中膜厚度(carotid intima-media thickness, CIMT)的影响。方法 选择2015-01至2019-01医院收治的CAPD患者96例为研究对象,采用彩色多谱勒超声测定CIMT,根据CIMT不同分为两组:增厚组CIMT≥1.0 mm,正常组CIMT＜1.0 mm,观察两组患者血磷(P)、超敏C-反应蛋白(hs-CRP)、白介素-6(IL-6)等指标差异。结果 CAPD患者中CIMT增厚的检出率为45.83%。单因素分析显示两组间患者年龄、糖尿病患数、血磷、hs-CRP、IL-6、TNF-α水平差异有统计学意义(P<0.05),多因素回归分析结果显示CAPD患者的血磷(P=0.003, OR=1.113)、hs-CRP (P=0.001, OR=1.148)、IL-6(P=0.016, OR=1.056)是CIMT增厚的独立危险因素。结论 CAPD患者中CIMT增厚与血磷、hs-CRP、IL-6等因子有关,是CAPD患者出现血管钙化,进而出现心血管事件并发症的重要危险因素。     

不同腹膜转运特性对持续性非卧床腹膜透析患者营养状态的影响

目的评价腹膜转运特性与持续性非卧床腹膜透析(CAPD))患者营养状况之间的关系。方法按照腹膜平衡试验(PET)计算结果,将62例稳定的CAPD患者分为高转运(H)组和低转运(L)组。测定血浆和腹透透出液营养指标:总蛋白、白蛋白(Alb)、前白蛋白(PA)、转铁蛋白(TF),并计算蛋白质分解率(nPCR)、标准化总氮出现率相当蛋白(nPNA)、瘦体质量%(LBM%)。同时观察透析充分性指标:每周总肌酐清除率(TCcr/W)与每周尿素清除指数[Kt/(v.W)],进行主观综合性营养评估(SGA)。比较两组营养状态及分析相关因素。结果两组患者一般资料比较:H组患者腹透液与血中肌酐比值(D/Pcr)和TCcr显著高于L组(P<0.05),而血肌酐(Scr)水平较L组显著降低(P<0.01),H组每日经腹透液丢失的总蛋白质、Alb均显著高于L组(P<0.05)。两组患者营养状况指标比较:H组的Alb、TF水平和SGA评分显著低于L组(P<0.05),其他营养指标也低于L组,但差异无统计学意义(P>0.05)。血中及经腹透透出液丢失的白蛋白与转运类型相关。结论高转运腹膜透析患者营养状态较低转运者差,故应加强对高转运CAPD患者的营养管理及饮食指导。     

碳酸司维拉姆对慢性肾功能衰竭合并高磷血症患者炎性因子及钙、磷代谢影响

目的探讨碳酸司维拉姆对慢性肾功能衰竭(CRF)合并高磷血症患者血清炎性因子及钙、磷代谢的影响。方法选取自2017年2月至2018年2月沧州市中心医院收治的80例CRF合并高磷血症患者为研究对象,按随机数字表法将其分为观察组与常规组,每组各40例。常规组患者口服醋酸钙治疗,观察组口服碳酸司维拉姆片。记录并比较两组患者的血清炎性因子、血红素过氧化酶1(HO-1)、全段甲状旁腺素(iPTH)水平,血管钙化程度,血钙、血磷水平及钙磷乘积。结果治疗后,两组患者血清肿瘤坏死因子α、白细胞介素-6、C反应蛋白、HO-1及iPTH水平均低于治疗前,且观察组低于常规组(P<0.05)。治疗后,血磷水平及钙磷乘积较治疗前降低,且观察组钙磷乘积低于常规组(P<0.05);常规组血钙水平高于治疗前(P<0.05),且高于观察组(P<0.05)。观察组重度钙化发生率低于常规组(P<0.05)。结论碳酸司维拉姆可有效降低CRF合并高磷血症患者炎性因子、HO-1及iPTH水平,改善钙、磷代谢,减轻血管钙化程度。     

X-Strain技术评价低钙透析液对血液透析患者颈动脉弹性的影响

目的 应用速度矢量成像技术（X-Strain）检测低钙透析液对维持性血液透析（MHD）患者颈动脉形变能力及弹性的早期影响.方法 应用X-Strain技术检测30例未发生形态学颈动脉粥样硬化的MHD患者使用低钙透析液前后颈动脉形变能力及弹性的变化.结果 ①使用低钙透析液后MHD患者血钙、血磷、钙磷乘积均降低,甲状旁腺素升高,差异有统计学意义;②使用低钙透析液后,入组前未发生形态学颈动脉粥样硬化的MHD患者颈动脉IMT、RI降低,EDV升高,差异有统计学意义;③使用低钙透析液后,入组前未发生形态学颈动脉粥样硬化的MHD患者颈动脉X-Strain参数,S1、S2、S3、S4、S6、Sr1、Sr2、Sr3、Sr4、Sr5、Sr6、CS、CSr均升高,差异有统计学意义;④CS、CSr与血钙、钙磷乘积、IMT、RI有明显相关性;⑤一元线性回归分析示,血钙、钙磷乘积、IMT、RI对CS、CSr有显著影响,其中血钙对CS及CSr的独立影响力最大.结论 应用X-Strain技术能检测出低钙透析液对未发生形态学颈动脉粥样硬化的MHD患者颈动脉形变能力及弹性的影响,为预防血管异位钙化问题提供新的治疗佐证.     

Peritoneal calcification: causes and distinguishing features on CT

OBJECTIVE: We undertook this study to determine the causes of peritoneal calcification seen on CT and to investigate which CT features distinguish benign from malignant peritoneal calcification. MATERIALS AND METHODS: Seventeen patients with peritoneal calcification were identified through retrospective review of reports from 74765 abdominopelvic CT examinations performed during a 7-year period. We determined the cause of peritoneal calcification by examining medical and histopathologic records. Calcification morphology was classified as nodular or sheetlike on the basis of the consensus interpretation by two independent radiologists. The radiologists also recorded the presence or absence of associated soft-tissue components or lymph node calcification. The association between the CT findings and the cause of calcification was assessed using chi-square analysis. RESULTS: Peritoneal calcification was due to peritoneal dialysis (n = 4), prior peritonitis (n = 3), cryptogenic origin (n = 1), or peritoneal spread of ovarian carcinoma (n = 9). Sheet-like calcification was more common in patients with benign calcification (seven of eight patients) than in those with malignant calcification (two of nine patients, p < 0.05). Nodal calcification was seen only in patients with malignant calcification (five of nine patients vs none of eight, p < 0.05). CONCLUSION: Common causes of peritoneal calcification are dialysis, prior peritonitis, or ovarian cancer; sheetlike calcification indicates a benign cause, whereas associated lymph node calcification strongly suggests malignancy.     

Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery

OBJECTIVES: The purpose of this study was to assess the diagnostic accuracy of the panoramic radiograph in the detection of carotid artery calcification using CT as the gold standard. METHODS: 110 dental patients (average age 65.2 years, range 50-82 years) with both panoramic radiographs and CT scans available were selected for the evaluation of carotid artery calcification. Two oral and maxillofacial radiologists interpreted the panoramic radiographs for the presence of carotid artery calcification. CT scans were independently interpreted by a neuroradiologist. RESULTS: The accuracy of panoramic radiographs in the detection of carotid artery calcification was 62.3%. The sensitivity and the specificity were 22.2% and 90.0%, respectively. CONCLUSIONS: Panoramic radiography has a moderate diagnostic accuracy in the detection of carotid artery calcification, but the sensitivity is low.     

阿托伐他汀对腹膜透析患者同型半胱氨酸及颈动脉内膜中层厚度的影响

目的观察阿托伐他汀对持续性非卧床腹膜透析（CAPD）患者血浆同型半胱氨酸（Hcy）、超敏C反应蛋白（hs-CRP）、低密度脂蛋白胆固醇（LDL-C）及颈动脉内膜-中层厚度（CCA-IMT）的影响。方法将60例CAPD患者随机分为阿托伐他汀组和常规治疗组,两组均给予常规治疗,阿托伐他汀组另给予阿托伐他汀20mg/d,疗程为24周,比较两组治疗前和治疗后Hey、hs-CRP、LDL-C及CCA-IMT的变化。结果治疗后,阿托伐他汀组Hey、hs-CRP、LDL-C及CCA-IMT均较对照组下降,差异有统计学意义（P〈0．05）,阿托伐他汀组CCA-IMT治疗后较治疗前显著降低,差异有统计学意义（P〈0．01）;相关分析显示Hcy等指标变化与LDL-C下降之间无相关关系。结论阿托伐他汀能降低CAPD患者Hcy水平及CCA-IMT,延缓动脉硬化的进展;抗动脉硬化作用可能独立于调脂作用之外。     

Intracranial carotid calcification on CT images as an indicator of atheromatous plaque: analysis of high-resolution CTA images using a 64-multidetector scanner

PURPOSE: Intracranial arterial wall calcifications are frequently observed on routine head computed tomography (CT) images. The purpose of this study was to evaluate whether calcification of the intracranial carotid artery on CT images could predict atheromatous plaque and luminal stenosis. MATERIALS AND METHODS: A total of 259 patients were examined using three-dimensional CT angiography using high-resolution 64 detector scanners. We examined patients from the petrous portion to the top of the internal carotid arteries. We evaluated the existence of calcification and atheromatous plaque based on our criteria retrospectively. The thickness of calcification was measured in each vessel, and the shape of calcification was classified into three types. RESULTS: There was low correlation between the thickness of the calcification and luminal stenosis, but the shape of the calcification corresponded well to the stenosis. The population of patients with >50% stenosis of the intracranial carotid artery differed statistically significantly for each calcification shape. There was a high negative predictive value (97.7%) in the correlation between the existence of calcification and atheromatous plaque on the multidetector CT images. CONCLUSION: Calcification of the intracranial carotid artery on CT images shows a high negative predictive value for the existence of atheromatous plaque in the same artery. The thickness of the calcification did not correlate well with luminal stenosis, but its shape seemed to predict luminal stenosis.     

Calcium at the carotid siphon as an indicator of internal carotid artery stenosis

Objectives

Carotid siphon calcification is often visible on unenhanced head CT (UCT), but the relation to proximal carotid artery stenosis (CAS) is unclear. We investigated the association of carotid siphon calcification with the presence of CAS.

Methods

This IRB-waived retrospective study included 160 consecutive patients suspected of stroke (age 64?±?14 years, 63 female) who underwent head UCT and CTA of the head and neck. CAS was rated on CTA as not present or present with non-significant (<50 %), moderate (50–69 %) or significant (≥70 %) stenosis. Presence, shape (on UCT) and volume (on CTA) of carotid siphon calcifications were related to CAS.

Results

Carotid siphon calcification was absent in 41 % of patients and bilateral in 94 % of those with calcifications. Presence, shape and volume of calcification resulted in odds ratios for having significant CAS of 10.1, 3.9 and 8.4, with 95 % CIs of 1.3–79.6, 1.1–14.1 and 2.6–26.8, respectively. Corresponding NPVs were 0.98, 0.98 and 0.96, while PPVs were 0.14, 0.07 and 0.29, respectively.

Conclusion

Absence of calcification in the carotid artery siphon on UCT has high negative predictive value for carotid artery stenosis in patients with suspected stroke. However, siphon calcification is not a reliable indicator of significant carotid artery stenosis.

Key Points

? Many stroke patients do not have calcification in the carotid artery siphon. ? Carotid stenosis ≥50?% is unlikely in stroke patients without siphon calcification. ? Carotid siphon calcium is a poor indicator of significant carotid artery stenosis.     

Cavernous carotid artery calcification and white matter ischemia

BACKGROUND AND PURPOSE: The relevance of cavernous carotid artery calcification on unenhanced CT scans of the brain has recently been investigated against the backdrop of the widespread implementation of coronary artery calcification scoring. We sought to determine whether the degree of cavernous carotid artery calcification correlated with scores of white matter hyperintensity seen on MR images. In so doing, we sought to establish a relative risk for future stroke on the grade of carotid calcification. METHODS: Neuroradiologic findings in 187 patients who underwent CT and MR imaging examinations within 1 month of each other were retrospectively reviewed. The degree of circumferential calcification and thickness of calcification were graded for the cavernous carotid arteries on the basis of CT findings. Using the scale developed by the Cardiovascular Health Study, the white matter was graded for degree of disease on the basis of MR findings. Correlation tests and regression analyses were performed to determine the impact of age, race, and sex on results. RESULTS: Although the cavernous carotid calcification scores and the MR imaging white matter scores showed good correlation (P <.001), the effect was mediated by age. With age factored in as a covariant, no correlation was shown between CT calcification scores and MR imaging white matter scores. Sex had no effect, but African American study participants had worse MR imaging white matter scores than did white participants. CONCLUSION: After adjusting for age, cavernous carotid calcification grades and MR imaging white matter scores do not show a significant correlation. The relative risk for future stroke cannot be predicted from cavernous carotid calcifications.     

Association between calcification of the cervical carotid artery bifurcation and white matter ischemia

BACKGROUND AND PURPOSE: The association of cervical carotid artery bifurcation calcification to future stroke risk is unknown, though coronary artery calcification is a proven indicator of heart disease risk. Severity of white matter change has been correlated with future stroke risk. We sought to use white matter severity grade on CT as a surrogate predictor of relative future stroke risk and thus correlate white matter and future stroke risk with carotid calcification grade. METHODS: We retrospectively reviewed unenhanced neck and brain CTs in 209 patients. Carotid calcification degree was scored by the Agatston method, adapted from that commonly used to quantify coronary artery calcification. White matter change severity was scored by the European Task Force for Age-Related White Matter Change scale. Both scores were measured blinded to each other, and to age and sex covariables. Association was tested by univariate and multivariate analyses. RESULTS: Both carotid calcification and white matter scores were strongly, and independently, associated with increasing age (r = 0.61, P < .001; and r = 0.67, P < .001, respectively). Despite apparent association between carotid calcification and white matter scores on univariate analysis, there was no independent effect evident after adjusting for age as a covariant (r = 0.07, P = .14). Sex had no independent effect on white matter scores, though men had a marginally higher mean calcified carotid plaque load than women after controlling for age (P = .008). CONCLUSIONS: Carotid calcification scores do not independently predict severity of white matter ischemia. Future stroke risk, assessed by white matter severity scores, cannot be predicted from carotid calcium scores.