营养不良-炎症综合征对维持性血液透析患者心血管钙化的影响

Effects of malnutrition inflammation complex syndrome on cardiovascular calcification in maintenance hemodialysis patients

摘要:

目的  探讨维持性血液透析（MHD）患者营养不良-炎症综合征与心血管钙化之间的关系。方法  选取MHD≥3个月的非住院患者60例，完善相关实验室检查，腹部侧位平片检测腹主动脉钙化（AAC）情况，心脏超声检测心脏瓣膜钙化情况，通过营养不良炎症评分（MIS评分）对患者的营养不良炎症状态进行评估，把其分为轻度（MIS≤4）、中度（5≤MIS≤8）及重度组（MIS≥9）。结果  营养不良炎症状态发生率为100%，其中轻度19例（31.7%）、中度27例（45%）、重度14例（23.3%）。心血管钙化发生率为68.3%，AAC发生率为48.3%，瓣膜钙化发生率为51.7%。年龄、血Ca及MIS评分在有、无心血管钙化两组之间差异有统计学意义。随着MIS评分的增高，心脏瓣膜钙化的发生率也增加。Logistic回归分析显示，MIS评分是心脏瓣膜钙化的危险因素。结论  维持性血液透析患者普遍存在营养不良-炎症综合征（MICS），MICS越严重其心脏瓣膜越容易发生钙化，而且MICS是心脏瓣膜钙化的危险因素。

关键词:

维持性血液透析;营养不良-炎症综合征;腹主动脉钙化;瓣膜钙化

Abstract:

Objective To explore the relationship between malnutrition inflammation complex syndrome (MICS) and cardiovascular calcification in maintenance hemodialysis (MHD) patients. Methods Sixty patients with MHD ≥3 months were enrolled into this respective study. The relevant laboratory examinations were completed. Abdominal aortic calcification score (AACS) was determined by abdominal lateral radiographs, and the valve calcification was detected by cardiac ultrasonography. The malnutrition inflammation score (MIS score) was used to test MICS of the MHD patients. The patients with MICS were divided into mild (MIS ≤ 4), moderate (5 ≤ MIS ≤ 8) and severe groups (MIS ≥ 9). Results The MICS occurrence was 100.0％, including 19 cases (31.7%) in the mild group, 27 cases (45.0%) in the moderate group, and 14 cases (23.3%) in the severe group. The cardiovascular calcification occurrence was 68.3％, the AAC occurrence was 48.3%, the valve calcification occurrence was 51.7%. The two groups of patients with or without cardiovascular calcification showed significant differences in age, blood calcium, and MIS score. Logistic regression analysis showed that MIS score was the risk factor for cardiovascular calcification. Conclusions MHD patients have widespread malnutrition inflammation complex syndrome (MICS). The more serious the MICS is, the more easily the cardiovascular calcification occurs. Moreover, MICS is the risk factor for cardiac valve calcification.

Key words:

maintenance hemodialysis; malnutrition inflammation complex syndrome; abdominal aortic calcification; valve calcification