血液透析患者心脏瓣膜钙化及其危险因素

目的观察尿毒症血液透析患者心脏瓣膜钙化(VC)情况并分析其危险因素。方法使用HDI-5000彩色超声诊断仪检测222例尿毒症维持性血液透析(HD)患者心脏VC情况,将患者分为VC组与无VC组,比较两组患者SGA评分、血压、透析前血红蛋白(Hb)、血清白蛋白(Alb)、前白蛋白(pAlb)、血钙、血磷、全段甲状旁腺激素(iPTH)、血脂及C反应蛋白(CRP)等指标。结果VC组76例(34.2%),无VC组146例(65.8%)例。VC组年龄显著大于无VC组,肾衰竭病程显著长于无VC组,高血压持续时间、吸烟年支数、中～重度营养不良者比例、CRP、血钙、血磷及iPTH等都显著高于无VC组,Alb及pAlb显著低于无VC组。多因素分析显示Alb<30g/L、pAlb<200mg/L、SGA评分中～重度及CRP>5mg/L均与VC显著相关。结论VC发生不仅与年龄、肾衰竭病程、高血压持续时间、吸烟年支数、钙磷代谢紊乱及继发性甲状旁腺功能亢进有密切联系,而且与炎症和营养不良显著相关,患者心脏的发生是多种因素综合作用的结果。

Cardiac valve calcification in hemodialysis patients and related risk factors

Objective To observe the cardiac valve calcification(VC) in uremic hemodialysis patients and to analyze the related risk factors. Methods The color doppler ultrasonography was performed on 222 uremic hemodialysis patients to detect the cardiac VC. The patients were divided into two groups: VC group and no VC group. The SGA score, blood pressure,hemoglobin, plasma albumin, pre albumin, lipid profile, calcium, phosphate, C responsive protein(CRP) and parathyroid hormone before dialysis were determined.Results Compared with patients with no VC,patients with VC were older, had longer renal failure and hypertension course,higher proportion of patients with moderate to severe malnutrition, plasma calcium, phosphate, parathyroid hormone and CRP, lower serum albumin and pre albumin. Conclusion Aging, course of renal failure and hypertension, smoking habit, abnormal calcium phosphate metabolism, secondary hyperparathyroidism,inflammation and malnutrition are associated with cardiac VC. The major risk factors for cardiac VC are inflammation and malnutrition.