营养不良、微炎症状态对腹膜透析患者心血管钙化的影响

目的 分析维持性腹膜透析患者营养不良、微炎症状态与心血管钙化的相关性, 并探讨心血管钙化的相关危险因素.方法 选择2016年1月至2017年12月昆明医科大学第二附属医院行持续性非卧床腹膜透析 (CAPD) 患者81例, 完善该81例患者相关实验室检查、人体测量, 行超声心动图评估其心脏瓣膜钙化 (CVC) 、腹部侧位片了解其腹主动脉钙化 (AAC) 情况, 采用改良定量主观整体评估表 (MQSGA) ) 评估患者营养状况, 根据评分分为营养正常 (<10分) 、轻中度营养不良 (1120分) 、重度营养不良 (2135分) 组.结果 营养正常组24例 (29.6%) , 轻中度营养不良组41例 (50.6%) , 重度营养不良组16例 (19.8%) , 瓣膜钙化发生率为45.7%, 腹主动脉钙化发生率为24.7%, 心血管钙化发生率为55.6%.营养不良、微炎症状态在有无瓣膜钙化2组间差异有统计意义意义 (P<0.05) , 年龄 (P=0.006) 、透析龄 (P=0.048) 、前白蛋白 (P=0.015) 、磷 (P=0.007) 、钙磷乘积 (P=0.013) 、hs-CRP (P=0.004) 在瓣膜钙化组和非瓣膜钙化组之间差异有统计学意义.结论腹膜透析患者普遍存在营养不良、微炎症状态, 营养不良、微炎症状态越重心血管钙化发生率越高, 高龄、长透析龄、低前白蛋白、高磷、高钙磷乘积、hs-CRP升高是心脏瓣膜钙化的独立危险因素.

Effect of Malnutrition and Micro-inflammatory State on Cardiovascular Calcification in Patients with Peritoneal Dialysis

Objective To analyze the correlation between cardiovascular calcification and malnutrition and micro-inflammatory state, and to explore the related risk factors of cardiovascular calcification in patients with maintenance peritoneal dialysis.Methods From January 2016 to December 2017, 81 patients undergoing continuous ambulatory peritoneal dialysis (CAPD) at the Second Affiliated Hospital of Kunming Medical University were enrolled in the study. The related laboratory tests and body measurements were performed in the81 patients. Cardiac Valve Calcification (CVC) was estimated by transthoracic echocardiography and abdomen lateral radiographs to understand the status of abdominal aortic calcification (AAC) . Nutritional status was assessed by modified quantitative subjective global assessment table (MQSGA) , which was divided into normal nutrition (<10 points) , mild to moderate malnutrition (11-20 points) , and severe malnutrition (21-35 points) group. Results Twenty-four patients (29.6%) in the normal group, forty-one patients (50.6%) in the mild to moderate group, and sixteen patients (19.8%) in the severe group were found.The incidence of valve calcification, abdominal aorta calcification and cardiovascular calcification were 45.7%, 24.7%, and 55.6% respectively. Significant difference was found in malnutrition and micro-inflammatory state between the two groups with and without valve calcification. Age (P = 0.006) , dialysis age (P = 0.048) , prealbumin (P = 0.015) , phosphorus (P = 0.007) , calcium-phosphorus product (P = 0.013) and hs-CRP (P = 0.004) were significantly different between valvular and non-valvular calcification group. Conclusion Malnutrition and micro-inflammatory states can be found in most peritoneal dialysis patients.The more severe the malnutrition and micro-inflammatory state are, the higher the incidence of cardiovascular calcification is.Advanced age, years of dialysis, low prealbumin, high phosphorus, high calcium-phosphorus product, and elevated hs-CRP can be the independent risk factor of cardiovascular calcification.