慢性肾衰竭维持性腹膜透析患者心脏瓣膜钙化危险因素

目的探讨慢性肾衰竭维持性腹膜透析患者心脏瓣膜钙化病因及干预治疗的方法。方法将入选的46例慢性肾衰竭维持性腹膜透析患者随机分为两组：a组（常规腹透液治疗组）与b组（低钙腹透液治疗组）,观察治疗84周前后心脏瓣膜钙化及血生化指标的变化。结果a组患者84周后发生二尖瓣钙化4例,二尖瓣返流1例,二尖瓣面积减少致狭窄1例,主动脉瓣钙化5例,主动脉瓣返流1例;b组84周后仅发现二尖瓣钙化1例,主动脉钙化1例。瓣膜钙化发生率与患者血钙、血磷水平、钙磷乘积及PTH（全段甲状旁腺激素）相关。结论慢性肾衰竭维持性腹透患者心脏瓣膜钙化相当常见,高钙、高磷血症、高PTH为心脏瓣膜钙化的危险因素。低钙透析液能显著减少维持性腹透患者心脏瓣膜钙化风险。

Risk factors for cardiac valve calcification in patients with chronic renal failure on maintenance peritoneal dialysis

Objective To investigate the etiology and characteristics of cardiac valve calcification and its effects on cardiac structure and function in patients with chronic renal failure （CRF） on maintenance peritoneal dialysis. Methods 46 patients were equally divided into group A （normal-calcium dialysate） and B （low-calcium dialysate） randomly. Calcification, surface area, stenosis and insufficiency of the cardiac valves were measured within 84 weeks. Results In group A, echocardiography revealed mitral valve calcification （MAC） in 4 cases, mitral regurgitation （MR） in one case, roitral stenosis （MS） in one case, aoRtic valve calcification in 5 cases, and aortic regurgitation in one case. In group B, echocardiography revealed MAC in one case, anti aortic valve calcification in one case. The degree of calcification was closely related to hyperphosphoremia and calcium x phosphate. Conclusions Mitral and aortic valves are vulnerahle to calcification as the major change of the heart valves in patients with CRF on maintenance＇peritoneal dialysis. Hyperphosphoremia and calcium x phosphate are. the major risk factors for the development of eardiac valve calcification.