维持性血液透析患者血清脂联素与螺旋CT冠状动脉钙化积分关系的研究

目的探讨维持性血液透析（MHD）患者血清脂联素与螺旋CT冠状动脉钙化积分（CACS）的关系，分析影响MHD患者冠状动脉钙化的危险因素。方法选择27例MHD患者（MHD组）和13例健康体检者（对照组）为研究对象，采用酶联免疫吸附试验法测定血清脂联素，64排螺旋CT扫描心脏计算CACS，同时观察血红蛋白（Hb）、血钙、血磷、钙磷乘积、全段甲状旁腺激素（iPTH）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、白蛋白（Alb）和高敏C反应蛋白（hs-CRP）等。结果MHD组血清脂联素水平（15．00±7．47）mg／L]明显高于对照组（2．07±0．83）mg／L]，差异有统计学意义（P〈0．01）。MHD组24例（88．9％，24／27）存在不同程度的冠状动脉钙化（CACS〉0分），CACS平均655（0～3570）分，其中11例钙化严重（CACS≥400分）。对照组10例（10／13）存在冠状动脉钙化，CACS平均126（0～731）分，仅1例患者CACS≥400分。秩和检验显示MHD组CACS显著高于对照组，差异有统计学意义（P〈0．05）。CACS≥400分与CACS〈400分的MHD患者透析龄、舒张压、血磷、钙磷乘积和脂联素水平比较差异有统计学意义（P〈0．05或〈0．01）。Spearman相关分析显示，MHD患者CACS与透析龄、血磷、钙磷乘积、血肌酐和脂联素呈正相关（P〈0．01或〈0．05）。多元逐步回归分析显示钙磷乘积是CACS唯一的独立危险因素（P〈0．01）。结论MHD患者冠状动脉钙化严重，与透析龄、血磷、钙磷乘积、血肌酐和脂联素有关。

The study of association between serum adiponectin and coronary artery calcification score in maintenance hemodialysis patients

Objective To investigate the relations between serum adiponectin and coronary artery calcification score （CACS） and to find the risk factors for coronary artery calcification in maintenance hemodialysis（MHD） patients. Methods Twenty-seven MHD patients（MHD group） and 13 healthy persons （control group） were enrolled in this study. The serum adiponectin was measured by enzyme-linked immunosorbent assay method. CACS was calculated by multi-row spiral CT. The circulating parameters such as hemoglobin （Fib） ,calcium, phosphate, calcium-phosphate product,intact parathTroid hormone（iPTi-I ）, total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C）, albumin （Alb）, high sensitive C-reactive protein （hs-CRP）, and so on were detected. Results The level of serum adiponectin in MHD group （15.00 ± 7.47 ） mg/L ] was significantly higher than that in control group （2.07 ± 0.83 ） mg/L ], and there was significant difference （P 〈 0.01 ）. Coronary artery calcification（CACS 〉 0 score） was observed in 88.9% （24/27） in MHD group and 10/13 in control group. The mean CACS in MHD group was significantly higher than that in control group 655 （0 -3 570） scores vs. 126 （0 -731 ）scores] ,and there was significant difference （P 〈 0.05）. Eleven MHD patients and 1 healthy person had severe coronary artery calcifications, （CACS≥400 scores）. There was significant difference in dialysis duration, diastolic pressure, phosphate calcium-phosphate product and adiponectin （P 〈 0.05 or 〈 0.01 ）. Spearman analysis showed that CACS of MHD patients was positively correlated with dialysis duration, phosphate, calcium-phosphate product, serum creatinine and adiponectin （P 〈 0.01 or 〈 0.05）. Only calcium-phosphate product remained as independent predictor of CACS in multivariate analysis （P 〈0.01）. Conclusion Coronary artery calcification is common in MHD patients and which is correlated with dialysis duration, serum phosphate, calcium-ph