心脏瓣膜钙化对血液透析患者冠状动脉钙化积分的预测价值

目的利用超声心动图研究终末期肾病血液透析患者心脏瓣膜钙化情况，探讨瓣膜钙化对冠状动脉钙化的预测价值。 方法对169例慢性肾病V期血液透析患者进行超声心动图检查评价心脏瓣膜钙化情况，并用多层螺旋CT扫描计算冠状动脉钙化积分。按照冠状动脉钙化积分11~100、101~400和≥400将患者分为3个危险等级；并根据心脏瓣膜钙化情况，将所有患者分为：无瓣膜钙化组、主动脉瓣钙化组、二尖瓣钙化组以及主动脉瓣、二尖瓣同时钙化组。Logistic回归分析瓣膜钙化与冠状动脉钙化积分危险分级之间的比值比。 结果受检的169例血液透析患者中88例（52.07%）患者存在瓣膜钙化。当患者出现主动脉瓣钙化时，冠状动脉钙化积分≥400的比值比为4.61，95%可信区间为1.22~17.4（P=0.02），出现二尖瓣钙化时，冠脉钙化积分≥400的比值比为5.31，95%的可信区间为1.37~20.5（P=0.01），当出现主动脉瓣、二尖瓣同时钙化时，冠状动脉钙化积分≥400的比值比为16.94，95%可信区间为5.16~55.58（P=0.001）。 结论血液透析患者心脏瓣膜钙化与冠状动脉钙化之间存在显著的相关性，超声心动图评价瓣膜钙化可以预测透析患者冠状动脉钙化的出现及危险分级。

Cardiac valve calcification by echocardiography predicts coronary artery calcium scores in dialysis patients

ObjectiveTo determine whether cardiac valve calcification on echocardiography could predict coronary artery calcium scores (CACS) in hemodialysis patients. MethodsThis was a cross-sectional study of 169 stage V hemodialysis patients. The presence of calcification of the cardiac valves was assessed by echocardiography. All patients underwent multi-slice spiral computed tomography for quantification of CACS. According to CACS, they were divided into 3 groups (11-100, 101-400, and≥400). According to cardiac valve calcification, they were divided into 4 groups: no valve calcification, aortic valve calcification, mitral valve calcification and aotic/mitral valve calcification. Logistic regression was used to calculate the odds ratios (ORs) of having a CACS greater than 10, 100 and 400 in presence of valve calcification. ResultsEighty-eight patients (52.07%) had echocardiographic evidence of valvular calcification. Patients with aortic valve calcification, mitral valve calcification and aotic/mitral valve calcification had a significantly greater likelihood of having CACS≥400 OR=4.61, 95% confidence interval (95%CI) 1.22-17.4, P=0.02; OR = 5.31, 95%CI 1.37-20.5, P=0.01; OR = 16.94, 95%CI 5.16-55.58, P=0.001]. ConclusionsThe cardiac valve calcification in hemodialysis patients was strongly associated with the presence and degree of CACS independently of clinical risk factors. Echocardiography is a useful method to predict CACS in hemodialysis patients by detecting cardiac valve calcification.