维持性血液透析患者腹主动脉钙化特点及影响因素分析

    Clinical characteristics and influencing factors of abdominal aorta calcification in maintenance hemodialysis patients

    • 摘要: 目的 探讨维持性血液透析患者腹主动脉钙化的相关影响因素,为血管钙化的预防和治疗提供新思路。方法 筛选航天中心医院血液净化中心70例维持性血液透析患者作为研究对象,收集患者临床实验室数据,应用腹部侧位片kauppila半定量积分法检测腹主动脉钙化评分情况,将70例患者分为对照组(钙化积分<5分)和病例组(钙化积分≥ 5分)。采用多因素Logistic回归分析并建立ROC曲线评价各影响因素对腹主动脉钙化的预测价值。结果 70例透析患者腹主动脉钙化积分(7.34±6.84)分,其中对照组31例,病例组39例。单因素结果提示病例组患者年龄、透析龄、超敏C反应蛋白(hypersensitive c-reactive protein,hs-CRP)、血钙和体质量指数水平明显高于对照组,高密度脂蛋白水平低于对照组,差异均具有统计学意义(P<0.05)。相关分析和多因素Logistic回归分析结果显示年龄、血钙和Hs-CRP水平增加是维持性血液透析患者腹主动脉中重度钙化的独立危险因素(P<0.05)。ROC曲线分析显示年龄、血钙和hs-CRP的诊断界值分别是60.5岁、2.21 mmol/L和1.09 mg/dL,灵敏度与特异度分别0.667与0.667、0.769与0.452、0.897与0.677。当年龄+血钙+hs-CRP联合预测时灵敏度与特异度0.872和0.677,AUC曲线下面积0.801。结论 维持性血液透析患者腹主动脉血管钙化发生率高,且程度较重。年龄、hs-CRP和高血钙是其独立危险因素。

       

      Abstract: Objective This study is to explore the influencing factors of abdominal aortic calcification and to provide new ideas for the prevention and treatment of vascular calcification in maintenance hemodialysis patients.Methods Seventy patients with maintenance hemodialysis in the blood purification center of the Aerospace Center Hospital were selected as the research objects.The clinical laboratory data of the patients were collected.Kaupplia's semi-quantitative scoring method for abdominal lateral radiographs were used to detect the abdominal aortic calcification scores,For scoring,dialysis patients were divided into control group (calcification score <5 points) and case group (calcification score ≥ 5 points).Multivariate logistic regression analysis was used and ROC curve was established to evaluate the predictive value of each influencing factor for abdominal aortic calcification.Results The average abdominal aortic calcification score of 70 patients was (7.34±6.84) points,including 31 cases in the control group and 39 cases in the case group.The univariate analysis results suggested that the patient group's age,dialysis age,hypersensitive c-reactive protein(hs-CRP),blood calcium and body mass index levels were significantly lower than those in the control group,and the level of high-density lipoprotein was lower than that in the control group,with all statistically significant differences (P<0.05).Correlation analysis and multivariate logistic regression analysis showed that age,increased blood calcium and high-sensitivity C-reactive protein levels were independent risk factors for moderate and severe abdominal aortic calcification in maintenance hemodialysis patients (P<0.05).ROC curve analysis showed that the diagnostic cut-off values of age,blood calcium,and hs-CRP were 60.5 years old,2.21 mmol/L and 1.09 mg/dL,respectively; and sensitivity and specificity were 0.667 and 0.667,0.769 and 0.452,0.897 and 0.677,respectively.When age,blood calcium and hs-CRP were combined for prediction,sensitivity and specificity were 0.872 and 0.677,and the area under the AUC curve was 0.801.Conclusions The incidence of abdominal aortic vascular calcification in maintenance hemodialysis patients is high,with high severity.Age,hs-CRP and hypercalcemia are its independent risk factors.

       

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