维持性血液透析患者心脏瓣膜钙化相关危险因素分析

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者心脏瓣膜钙化发生的相关危险因素。方法入选2011年7月前在上海交通大学医学院附属瑞金医院血液透析中心的MHD患者,年龄超过18周岁,透析龄在3个月以上,排除心脏外科瓣膜手术后患者。应用超声心动图检测心脏瓣膜钙化,采用双位点酶联免疫吸附法(ELISA)检测血浆C段成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)。应用Logsitic回归分析心脏瓣膜钙化的相关危险因素。结果资料完整的患者共110例,男性64例,女性46例,平均年龄55.2岁(20~85岁),平均透析龄41.7月(3.0~225.5月)。110患者中,共有28例(25.5%)发生心脏瓣膜钙化(主动脉钙化或二尖瓣瓣膜钙化),其中主动脉瓣膜钙化(AVC)25例(22.7%),二尖瓣瓣膜钙化(MVC)10例(9.1%),AVC和MVC双瓣膜钙化6例(5.5%)。比较合并瓣膜钙化和非瓣膜钙化2组患者各项临床指标,发现合并瓣膜钙化患者年龄更大、透析龄更长、白蛋白水平更低,血磷水平更高,FGF23水平更高。应用多因素Logistic回归,结果发现老龄(OR=1.106)、透析龄长(OR=1.031)、低白蛋白(OR=0.852),高血磷(OR=7.420)是透析患者发生心脏瓣膜钙化的主要危险因素(通过性别、总蛋白、尿素氮、肌酐、尿酸、血钙、胆固醇、三酰甘油、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、全段甲状旁腺素(iPTH)和LgFGF23校正后,Backward Stepwise,P<0.001,Nagelkerke R Square 0.555)。结论 MHD患者主动脉及二尖瓣钙化多发,其中以主动脉瓣膜钙化更多见。老龄、透析龄长、低白蛋白、高血磷是心脏瓣膜钙化的独立危险因素。

Risk factors of cardiac valve calcification in maintenance hemodialysis patients

Objective To explore the risk factors for cardiac valve calcification in maintenance hemodialysis（MHD） patients.Method Patients on hemodialysis for at least 3 months in Ruijin Hospital before July 2011,aged over 18 years,and without history of surgery or catheterization for cardiac valve disease were enrolled in this study.Echocardiography was used to detect the calcification.Fibroblast growth factor 23（FGF23） was measured by ELISA.The risk factors for valve calcification were analyzed by logistic regression method.Results One hundred and ten MHD patients（64 men and 46 women） with the mean dialysis duration of 41.7 months were enrolled in the study.In the 110 patients,cardiac valve calcification was found in 28 patients（25.5%）,in which aortic valve calcification was found in 25 patients（22.7%）,mitral valve calcification in 10 patents（9.1%）,and both aortic and mitral valve calcification in 6 patients（5.5%）.Patients with valve calcification had older age,longer dialysis duration,lower albumin level,higher serum phosphate and higher FGF23,as compared with the patients without valve calcification.Multivariate logistic regression showed that age（OR=1.106）,dialysis duration（OR=1.031）,albumin level（OR=0.852）,serum phosphate（OR=7.420） were independently correlated with cardiac valve calcification（backward stepwise,P〈0.001; Nagelkerke R2 0.555）.Conclusion Cardiac valve calcification is prevalent in MHD patients,especially aortic valve calcification.Older age,longer dialysis duration,lower albumin and hyperphosphatemia are the independent risk factors for cardiac valve calcification.