内脏脂肪面积和冠状动脉钙化评分与血液透析患者预后的关系

    Relationship between visceral fat area,coronary artery calcification score and prognosis of hemodialysis patients

      摘要
    • 摘要: 目的 探讨内脏脂肪面积（visceral fat area，VFA）和冠状动脉钙化评分（coronary artery calcification score，CACs）与维持性血液透析（maintenance hemodialysis，MHD）患者临床预后的关系。方法 选择2018年1月至2019年1月在我院行MHD的患者120例作为研究对象，采用非干预性横断面临床观察的方法，生物电阻抗分析法检测入院基线状态VFA，多层螺旋CT扫描和Agatston评分法计算基线状态CACs，根据受试者工作曲线（receiver operating curve，ROC）分析VFA和CACs预测CVEs的曲线下面积（area under curve，AUC）和最佳临界值，根据最佳临界值进行分组，比较组间患者的心血管事件（cardiovascular events，CVEs）、心血管死亡（cardiovascular death，CVD）和全因死亡率，比较组间患者CVEs的累积发生率，最后采用多因素Cox回归分析筛选CVEs、CVD和全因死亡的危险因素。结果 ROC显示，VFA和CACs预测CVEs的AUC值分别为0.82和0.73（P<0.05），临界值分别为108.6和73.6 cm2，120例患者分为CACs ≥ 108.6（n=45）和<108.6（n=75）、VFA ≥ 73.6 cm2（n=56）和<73.6 cm2（n=64），CACs ≥ 108.6组较<108.6组以及VFA ≥ 73.6 cm2组较<73.6 cm2组患者年龄增大、透析时间延长、糖尿病增多、CVEs、CVD和全因死亡率升高，差异有统计学意义（P<0.05）。Kaplan-Meier生存分析显示，CACs ≥ 108.6组较<108.6组以及VFA ≥ 73.6 cm2组较<73.6 cm2组CVEs的累积生存率降低（P<0.05）。Cox回归分析显示，VFA ≥ 73.6 cm2是CVEs、CVD和全因死亡的危险因素（P<0.05）。结论 VFA比CACs与MHD患者CVEs、CVD和全因死亡增加的关系更加密切，提示临床上应早期加强对VFA的监测。受限于样本量和观察时间，结果仍需进一步验证。

       

      Abstract: Objective To explore the relationship between visceral fat area (VFA),coronary artery calcification score (CACs) and clinical prognosis of maintenance hemodialysis (MHD) patients.Methods From January 2018 to January 2019,a total of 120 hospitalized MHD patients were recruited as research subjects.Baseline VFA was detected by bioelectrical impedance analysis and baseline CACs were calculated by multi-slice spiral CT scanning and Agatston scoring method.They were divided according to the optical cut-off.Area under curve (AUC) values of VFA/CACs in predicting cardiovascular events (CVEs) were analyzed by receiver operating curve (ROC).CVEs,cardiovascular death (CVD),all-cause mortality rate and cumulative incidence of CVEs were compared between two groups.Finally,the risk factors of CVEs,CVD and all-cause mortality were screened by multivariate Cox regression analysis.Results ROC indicated that AUC values of VFA/CACs in predicting CVEs were 0.82 and 0.73 respectively (P<0.05) and the cut-offs 108.6 and 73.6 cm2.They were divided into CACs ≥ 108.6 (n=45) and <108.6 (n=75),VFA ≥ 73.6 cm2 (n=56) and <73.6 cm2 (n=64).Compared with CACs<108.6 group,age of patients was older in CACs ≥ 108.6 group,dialysis time longer and diabetes rate higher.Also CVEs,CVD and all-cause mortality rate were greater too (P<0.05).Compared with VFA< 73.6 cm2 group,age of patients was older,dialysis time longer and diabetes rate higher in VFA ≥ 73.6 cm2 group.And CVEs,CVD and all-cause mortality rate were greater too (P<0.05).Kaplan-Meier survival analysis indicated that the cumulative survival rate of CVEs in CACs ≥ 108.6 group was lower than that in CACs<108.6 group and VFA ≥ 73.6 cm2 group was lower than that in VFA< 73.6 cm2 group (P<0.05).Cox regression analysis revealed that VFA ≥ 73.6 cm2 was a risk factor for CVEs,CVD and all-cause death (P<0.05).Conclusion VFA is more closely correlated with the elevations of CVEs,CVD and all-cause mortality in MHD patients than CACs.It suggests that early monitoring of VFA should be strengthened.Limited by sample size and observation time,the results should be further validated.

       

      • HTML全文
      • 参考文献(18)
      • 相关文章
      • 施引文献
    • 资源附件(0)

    /

    返回文章
    返回