慢性肾脏病5期糖尿病肾病与非糖尿病肾病患者心瓣膜钙化情况分析

目的观察慢性肾脏病（chronic kidney disease,CKD）5期糖尿病肾病和非糖尿病肾病患者心瓣膜钙化发生情况,探讨糖尿病肾病对心瓣膜钙化的影响。方法未行血液透析治疗的CKD 5期心瓣膜钙化患者104例,其中糖尿病肾病患者48例（DN组）,非糖尿病肾病患者56例（NDN组）,2组均行超声心动图检查,观察心瓣膜钙化发生部位及心瓣膜功能;采用多元线性逐步回归分析影响CKD患者心瓣膜钙化的危险因素。结果 104例患者超声心动图显示,心瓣膜钙化累及二尖瓣82例（78.84%）,累及主动脉瓣80例（76.92%）,累及三尖瓣26例（25.00%）;DN组钙化心瓣膜反流率（100.00%）、狭窄并关闭不全发生率（8.33%）高于NDN组（85.71%,0）（P〈0.05）,心瓣膜钙化发生部位与NDN组比较差异无统计学意义（P〉0.05）;多元线性逐步回归分析结果显示,空腹血糖增高、高三酰甘油、高龄、低25-羟维生素D水平是CKD患者发生心瓣膜钙化的危险因素。结论伴糖尿病肾病的CKD 5期非透析患者心瓣膜功能失调发生率较高,糖尿病肾病是CKD患者心瓣膜钙化危险因素。

Comparison of cardiac valve calcification between chronic kidney disease stage 5 patients with and without diabetic nephropathy

Objective To explore the influence of diabetic nephropathy（DN）on cardiac valve calcification by observing the incidence of cardiac valve calcification in chronic kidney disease（CKD）stage 5patients with or without DN.Methods In 104 undialysed CKD stage 5patients with cardiac valve calcification,48 patients were complicated with DN（DN group）and 56 patients with non-DN（NDN group）.All patients were performed echocardiography to compare the position of cardiac valve calcification and function of cardiac valve between two groups.Multiple linear stepwise regression analysis was used to analyze the risk factors for cardiac valve calcification in CKD patients.Results Echocardiography in104 patients showed cardiac valve calcification involving the mitral valve in 82patients（78.84%）,the aortic valve in 80patients（76.92%）and the tricuspid valve in 26patients（25.00%）.The incidences of cardiac valve reflux and stenosis complicated with closure insufficiency were higher in DN group（100.00%,8.33%）than those in NDN group（85.71%,0）（P〈0.05）,and there was no significant difference in the position of cardiac valve calcification between two groups（P〉 0.05）.The multiple linear stepwise regression analysis showed that high fasting plasma glucose,high triacylglycerol,the old age and lower level of 25-hydroxyvitamin D were risk factors for cardiac valve calcification in CKD patients.Conclusion The undialyzed CKD stage 5patients complicated with DN have a high incidence of valvular disfunction.DN is a risk factor for cardiac valve calcification in CKD patients.