老年慢性肾脏病3~5期非透析患者心脏瓣膜钙化特点及其与血清骨代谢标志物的相关性

洪维; 肖婧; 傅辰生; 张晓丽; 叶志斌

doi:10.12025/j.issn.1008-6358.2020.20200580

老年慢性肾脏病3~5期非透析患者心脏瓣膜钙化特点及其与血清骨代谢标志物的相关性

Cardiac valve calcification and its relationship with serum bone turnover markers in elderly patients with stage 3-5 non-dialysis chronic kidney disease

摘要

摘要:
目的探讨老年慢性肾脏病（CKD）3~5期非透析患者心脏瓣膜钙化发生率及其特点，分析其与血清骨代谢标志物（BTM）的相关性。
方法入选复旦大学附属华东医院肾内科病房老年CKD 3~5期非透析住院患者168例，其中男性80例，女性88例，年龄60~93岁。记录相关临床资料、血生化和骨代谢标志物指标，行心脏彩超检查，根据有无瓣膜钙化分为心脏瓣膜钙化（VC）组与非钙化（NVC）组。
结果 VC组的年龄、全段甲状旁腺素（iPTH）和Ⅰ型胶原羧基末端肽（β-CTX）显著高于NVC组（P < 0.05或P < 0.01），VC组的估算肾小球滤过率（eGFR）略低于NVC组（P < 0.05），碱性磷酸酶略高于NVC组（P < 0.05）。老年患者CKD 3~5期均以主动脉瓣钙化为最常见，二尖瓣钙化其次，三尖瓣最少见。CKD 4期和5期患者主动脉瓣钙化发生率（53.06%和39.75%）显著高于CKD 3期（25.00%，P < 0.05），而二尖瓣钙化发生率在各期间无明显差异（11.11%vs 8.16%vs 18.07%，P>0.05）。单因素Logistic回归分析发现，年龄、eGFR、β-CTX和iPTH与心脏瓣膜钙化显著相关（P < 0.05）。多因素Logistic逐步回归分析显示，年龄越大和iPTH越高是主动脉瓣钙化的独立危险因素（OR=1.102，95% CI 1.058~1.148，P < 0.01；OR=1.004，95% CI 1.001~1.007，P < 0.01）。年龄越大和β-CTX越高是二尖瓣钙化的独立危险因素（OR=1.104，95% CI 1.010~1.206，P < 0.05；OR=1.001，95% CI 1.000~1.002，P < 0.05）。
结论老年CKD 4~5期非透析患者VC发生率高，其中主动脉瓣钙化最常见，增龄是老年CKD 3~5期非透析患者VC的独立危险因素，常见的血清BTM与老年CKD患者中VC的相关性不大。

Abstract:
Objective The aim of this study is to determine the prevalence of cardiac valve calcification and its relationship with serum bone turnover markers in elderly patients with stage 3-5 non-dialysis chronic kidney disease (CKD).
Methods Totally, 168 elderly inpatients aged 60-93 years with stage 3-5 non-dialysis CKD (80 male, 88 female) were enrolled. Clinical data, serum blood biochemical and bone turnover marker examination results were collected and analyzed. Patients were divided into cardiac valve calcification (VC) group and non-cardiac valve calcification (NVC) group according to the echocardiography results.
Results Age, serum intact parathyroid hormone (iPTH), beta carboxyl-terminal cross-linking telopeptide of type I collagen (β-CTX), and ALP levels in the VC group were significantly higher than those in the NVC group (P < 0.05 or P < 0.01), whereas the eGFR level was lower than that in the NVC group (P < 0.05). Aortic valve calcification was the most common, followed by the mitral valve and tricuspid valve calcification in stage 3-5 CKD elderly patients. The prevalence of aortic calcification in stage 4 and 5 CKD patients (53.06% and 39.75%) was significantly higher than that in stage 3 CKD patients (25.00%, P < 0.05), while there was no significant difference in the prevalence of mitral valve calcification (11.11% vs 8.16% vs 18.07%, P>0.05). Binary logistic regression analysis showed that age, eGFR, β-CTX, and iPTH were significantly correlated with cardiac valve calcification (P < 0.05). Multivariate logistic regression analysis showed that older age and higher iPTH were independent risk factors for aortic valve calcification (OR=1.102, 95%CI 1.058-1.148, P < 0.01; OR=1.004, 95%CI 1.001-1.007, P < 0.01). Older age and higher β-CTX were independent risk factors for mitral valve calcification (OR=1.104, 95%CI 1.010-1.206, P < 0.05; OR=1.001, 95%CI 1.000-1.002, P < 0.05). However, the OR values of iPTH and β-CTX are close to 1, so there were no clinical significance.
Conclusions The prevalence of VC in stage 4-5 non-dialysis CKD elderly patients was high, among which aortic value calcification is the most common. Aging is an independent risk factor for VC in elderly patients with stage 3-5 non-dialysis CKD. The common serum bone turnover markers have little correlation with VC in elderly CKD patients.

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