腹膜透析患者心脏瓣膜钙化与颈动脉粥样硬化的关系及影响因素

Role and influencing factors of cardiac valve calcifcation and carotid atherosclerosis in peritoneal dialysis patients

摘要:

目的??调查腹膜透析患者心脏瓣膜钙化及颈动脉粥样硬化（CAS）的发生率，探讨两者的相关性及 影响因素。方法??选取南京医科大学附属无锡人民医院腹膜透析中心行规律腹膜透析≥ 3 个月的患者 166 例，收 集患者一般临床资料、 实验室检查资料， 并行心脏超声和颈动脉超声检查。结果??心脏瓣膜钙化组 46 例（27.7%） ， 无心脏瓣膜钙化组 120 例（72.3%） ， 心脏瓣膜钙化组患者 25- 羟维生素 D 水平为（18.32±10.64）ng/ml， 无心脏 瓣膜钙化组患者 25- 羟维生素 D 水平为（19.17±10.81）ng/ml，两组比较差异无统计学意义（ P >0.05） 。两 组比较，年龄、透析时间、收缩压、血清白蛋白、hs-CRP、IL-6 差异有统计学意义（ P <0.05） 。心脏瓣膜钙化 组合并 CAS 的患者 38 例（82.6%） ，无心脏瓣膜钙化组的 CAS 患者 50 例（41.7%） ，两者比较差异有统计学意义 （ P <0.05） 。既有心脏瓣膜钙化又有 CAS 的患者 38 例（A 组） ， 既无心脏瓣膜钙化又无 CAS 的患者 70 例（B 组） ， 两组间年龄、透析龄、收缩压、舒张压、血清白蛋白、LDL-C、hs-CRP、IL-6、iPTH 比较，差异有统计学意 义 （ P <0.05） 。二分类 Logistic 回归分析显示， 年龄、 收缩压与 hs-CRP、 IL-6 为心脏瓣膜钙化的危险因素 （ P <0.05） 。年龄、透析龄、收缩压、hs-CRP、IL-6、吸烟为同时患心脏瓣膜钙化合并 CAS 的危险因素（ P <0.05） 。结论? 腹膜透析患者心脏瓣膜钙化和 CAS 常常伴发， 心脏瓣膜钙化和 / 或 CAS 与患者年龄、血压、炎症相关。

Abstract:

Objective To investigate the relationship between cardiac valve calcification (CVC) and carotid atherosclerosis (CAS) and its clinical features in peritoneal dialysis (PD) patients. Methods A total of 166 patients who underwent regular PD duration of over 3 months in PD center of Wuxi people’s hospital were enrolled in this study. Their clinical and laboratory data were collected. CVC and CAS were confirmed by cardiac echocardiography and carotid artery color Doppler ultrasound examination. Results Among 166 PD patients, 46 were of CVC (27.7%). Serum level of [25 (OH) D] was comparable between patients with CVC or patients without CVC [(18.32 ± 10.64) VS (19.17 ± 10.81) ng/ml, P > 0.05]. Age, dialysis time, systolic BP, albumin, hypersensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6) were significantly different between CVC group and non-CVC group (P < 0.05). There are 38 patients with CAS in CVC group (82.6%), and 50 patients with CAS in non-CVC group (41.7%). Age, dialysis time, systolic BP, diastolic BP, albumin, LDL-C, hs-CRP, IL-6 and iPTH were significantly different between 38 CVC patients with CAS and 70 CAS patients without CVC (P < 0.05). Two classification logistic regression analysis showed that age, systolic BP, hs-CRP and IL-6 were the risk factors for CVC (P < 0.05), and age, dialysis time, systolic BP, hs-CRP, IL-6 and smoking were the risk factors for CVC and CAS (P < 0.05). Conclusions PD patients experience commonly with CVC and CAS; CVC and/or CAS are associated with age, BP and inflammation.