腹主动脉钙化进展对维持性血液透析患者预后的影响

目的探讨腹主动脉钙化(AAC)进展对维持性血液透析(MHD)患者预后的影响。方法纳入2014年6月至2014年10月于天津医科大学第二医院接受MHD治疗并完成基线及2年后腹部侧位X线片检查的患者,评估腹主动脉钙化积分(AAC score,AACs),根据AACs变化情况分为腹主动脉钙化快速进展组(AACs变化值>中位数)和非快速进展组(AACs变化值≤中位数),随访观察AAC进展对患者预后的影响。采用Kaplan-Meier生存分析比较两组的生存率,多因素Cox回归分析MHD患者全因死亡、心血管疾病死亡和心血管事件的危险因素。结果总共纳入MHD患者111例,其中男51例,女60例,年龄(52.24±12.69)岁;基线AAC患病率为45.9%(51/111),中位AACs为0(0,5)分;2年后AAC患病率为78.4%(87/111),中位AACs为6(2,11)分,其中AAC快速进展组(AACs变化值>2分)54例,非快速进展组(AACs变化值≤2分)57例,中位随访27.9(27.1,28.0)个月。Kaplan-Meier生存分析显示,AAC快速进展组的累积生存率明显低于AAC非快速进展组(Log-rank χ^2=5.695,P=0.017)。多因素Cox回归分析显示,高AAC基线值(HR=1.135,95%CI 1.001~1.286,P=0.048)、低血白蛋白(HR=0.789,95%CI 0.640~0.972,P=0.026)是MHD患者全因死亡的独立危险因素;高AAC基线值(HR=1.187,95%CI 1.038~1.356,P=0.012)、低尿素清除指数(HR=0.103,95%CI 0.013~0.801,P=0.030)是MHD患者心血管疾病死亡的独立危险因素;低尿素清除指数(HR=0.018,95%CI 0.003~0.115,P<0.001)、低血白蛋白(HR=0.736,95%CI 0.608~0.890,P=0.002)是MHD患者心血管事件的独立危险因素。结论腹主动脉钙化进展可能增加MHD患者心血管事件及死亡风险。腹主动脉钙化程度、透析充分性和营养状态是MHD患者预后的预测因子。

Effects of abdominal aortic calcification progression on outcomes in maintenance hemodialysis patients

Objective To investigate the effects of abdominal aortic calcification (AAC) progression on outcomes in maintenance hemodialysis (MHD) patients. Methods Patients who were on MHD between Jun. 2014 and Oct. 2014 in the dialysis center of the Second Hospital of Tianjin Medical University and finished the AAC examination at baseline and two years later were included prospectively. The progression of AAC by AAC score (AACs) at baseline and two years later was evaluated. According to the change of AACs, the patients were divided into rapid AAC progression group and non-rapid AAC progression group. The effect of AAC progression on outcomes in MHD patients in the follow-up period was investigated. Kaplan-Meier analysis was used to compare their survival rates. Multivariable Cox regression model was used to determine the risk factors of all-cause mortality, cardiovascular mortality and cardiovascular events. Results A total of 111 MHD patients were included, including 51 males and 60 females, aged (52.24±12.69) years. Baseline AAC prevalence was 45.9% (51/111), and median AACs was 0 (0, 5); After 2 years, the prevalence of AAC was 78.4% (87/111), and the median AACs was 6 (2, 11). There were 54 cases in the AAC rapid progression group (AACs change value＞2) and 57 cases in the non-rapid AAC progression group (AACs change value≤2). The median follow-up duration was 27.9(27.1, 28.0) months. Kaplan-Meier analysis showed that patients in rapid AAC progression group had a higher risk of mortality as compared to patients in non-rapid AAC progression group (Log-rank χ2=5.695, P=0.017). Multivariate Cox regression analysis demonstrated that high baseline AACs (HR=1.135, 95%CI 1.001-1.286, P=0.048), hypoalbuminemia (HR=0.789, 95%CI 0.640-0.972, P=0.026) were independent risk factors for all-cause mortality in MHD patients. High baseline AACs (HR=1.187, 95%CI 1.038-1.356, P=0.012), low spKt/V (HR=0.103, 95%CI 0.013-0.801, P=0.030) were independent risk factors for cardiovascular mortality in MHD patients. Low spKt/V (HR=0.018, 95%CI 0.003-0.115, P＜0.001), hypoalbuminemia (HR=0.736, 95%CI 0.608-0.890, P=0.002) were independent risk factors for cardiovascular events in MHD patients. Conclusions Abdominal aortic calcification progression may increase the risk of cardiovascular events and death in MHD patients. Severity of AAC, adequacy of dialysis, and nutritional status are predictors of outcomes in MHD patients.