腹膜透析患者心脏瓣膜钙化评估及相关因素分析

目的 探讨慢性肾脏病5期（chronic kidney disease stage 5,CKD5期）行规律腹膜透析（腹透）的老年患者心脏瓣膜钙化（cardiac valve calcification,CVC）的患病率及相关危险因素分析.方法 入选上海交通大学医学院附属仁济医院腹透中心稳定的接受规律腹透的60岁及以上CKD5期患者,采集患者的人口统计学资料,测定血压,检测生化指标,评估患者的残肾功能和透析充分性,记录用药情况,使用心脏多普勒超声仪检测患者的心脏瓣膜钙化情况.采用Logistic回归分析CVC的危险因素.结果 共有85例患者入选本研究,男性48例（56.5％）,中位年龄67 （62～73）岁,中位透析龄21 （10～41）m,23例（27.1％）合并糖尿病.其中45例（52.9％）患者存在心脏瓣膜钙化.与心脏瓣膜无钙化（Non-Cardiac valve calcification,NCVC）的患者相比,CVC患者的年龄[72 （66.5～77.5）岁vs 63 （61.0～65.8）岁,P＜0.01]较大;矫正钙[（2.4±0.2） mmol/L vs （2.3±0.2）mmol/L,P＜0.05]、左室射血分数[（67.6士6.3）％vs（62±9.3）％,P＜0.01]较高,前白蛋白[（329.1±74.6） g/L vs （372.7±80.4） g/L,P＜0.05]较低,室间隔[（11.2±2.4） mm vs（10.3±1.3）mm,P＜0.05]较厚.Logistic回归分析结果显示年龄（OR=1.243,95％CI 1.122～1.377,P＜0.01）是这些患者发生瓣膜钙化的独立危险因素,而前白蛋白（OR=0.992,95％CI 0.984～0.999,P＜0.05）是保护性因素.结论 CKD5期行规律腹透的老年患者心脏瓣膜钙化患病率较高.年龄是心脏瓣膜钙化的独立危险因素,前白蛋白是保护性因素.心脏多普勒超声操作简便、经济,易于临床推广,对老年腹透患者预后的预测价值有待更多的随访研究.

Assessment and analysis of cardiac valve calcification in peritoneal dialysis patients

Objectives To evaluate the incidence and associated factors of cardiac valve calcification （CVC） inchronic kidney disease stage 5 gerontal patients undergoing peritoneal dialysis （PD）. Methods Eligible PD patients above 60 years old in peritoneal dialysis center of Renji Hospital Shanghai Jiao Tong University School of Medicine were enrolled in present study. Demographic features, blood pressure, laboratory parameters, residual renal function, dialysis adequacy and medication were recorded. Echocardiography was used to assesse cardiac valves calcification. Risk factors for CVC were analyzed by Logistic regression analysis. Results A total of 85 PD patients [median age 67 （62- 73） years old, median PD vintage 21 （10-41） months] were enrolled in present study, within which 48 （56.5%） were male and 23 （27.1%） with diabetes mellitus. CVC was presented in 45 （52.9%） patients. Compared to those without CVC, patients with CVC were elder [72 （66.5-77.5） vs 63 （61.0-65.8） years old, P〈0.01], had higher corrected calcium [（2.4±0.2） mmol/L vs （2.3±0.2） mmol/L, P〈0.05], higher leftventricularejectionfraction [（67.6±6.3） vs （62±9.3） %, P〈0.01], thicker interventricular septum [（11.2±2.4） mm vs （10.3± 1.3） ram, P〈0.05], while their pre-albumin [（329.1 ±74.6） g/L vs （372.7±80.4） g/L, P〈0.05] were significantlylower. Logistic regressionanalysisidentifiedage （OR=1.243,95% CI 1.122- 1.377, P〈 0.01） as an independent risk factor for CVC, while pre-albumin （OR=0.992,95 %CI 0.984-0.999, P〈0.05） as a protect factor. Conclusion CVC was prevalent in gerotal patients undergoing peritoneal dialysis. Older age was an independent risk factor for CVC, and lower pre-albumin was a protect factor. The echocardiography was an inex- pensive, simple and promising tool for assessment of CVC, even though its prognostic value of gerontal PD patients required more follow-up studys.