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维持性血液透析患者心脏瓣膜钙化相关因素分析及其对预后的影响

Related factors and prognostic impact of cardiac valve calcification in maintenance hemodialysis patients

    摘要
  • 摘要:
    目的  探讨维持性血液透析（MHD）患者心脏瓣膜钙化（CVC）的相关因素，并评估CVC对心血管事件和死亡率的影响。
    方法 回顾性选择2019年6月30日至2024年6月30日在复旦大学附属金山医院肾内科持续进行MHD治疗的223例患者（2019年6月30日起1周内完成入组），根据是否合并CVC将患者分为CVC组和非CVC组，收集两组患者基线数据及5年随访数据。采用二元logistic回归分析CVC的相关因素。采用Kaplan-Meier生存曲线分析两组患者的生存率。采用Cox比例风险回归模型评估CVC对MHD患者生存率的影响。
    结果 223例MHD患者中，男性136例（61.0%），平均（58.4±13.5）岁，平均透析龄（64.0±55.4）个月，117例（52.5%）合并CVC。年龄、透析龄、糖尿病肾病（DKD），血清校正总钙、磷、全段甲状旁腺激素（iPTH）、高敏C反应蛋白（hsCRP）和同型半胱氨酸（Hcy）水平是CVC的独立相关因素（P＜0.05）。与非CVC组相比，CVC组患者5 年全因死亡率（46.6% vs 28.7%）和心血管疾病死亡率（33.3% vs 16.0%）均升高（P＜0.01）。
    结论 年龄、透析龄、原发病、钙磷代谢、炎症及营养相关因素与MHD患者 CVC 风险独立相关，且CVC 提高 MHD 患者的死亡风险。

     

    Abstract:
    Objective To explore risk factors for cardiac valve calcification (CVC) in maintenance hemodialysis (MHD) patients and evaluate its impact on cardiovascular events and mortality.
    Methods Retrospective selection of 223 patients with MHD admitted to the Department of Nephrology of Jinshan Hospital, Fudan University from June 30, 2019 to June 30, 2024, and enrollment completed within one week of June 30, 2019. Patients were divided into CVC and non-CVC groups. Baseline data and 5-year follow-up data were collected. The binary logistic regression analysis was performed to explore the risk factors for CVC. Kaplan-Meier survival curve was used to analyze the survival rate of patients. Cox proportional hazard regression model was applied to evaluate the impact of CVC on the survival rates of MHD patients.
    Results Totally, 223 MHD patients with an average age of (58.4±13.5) years and an average dialysis duration of (64.0±55.4) months were involved. Among them, 136(61.0%) were males, 117(52.5%) were complicated with CVC. Age, dialysis duration, diabetic kidney disease (DKD), the serum corrected total calcium and phosphate, intact parathyroid hormone (iPTH), high-sensitive C-reactive protein (hsCRP), and homocysteine (Hcy) were independent related factors for CVC (P＜0.05). Both all-cause mortality (46.6% vs 28.7%) and cardiovascular mortality (33.3% vs 16.0%) were significantly higher in the CVC group than those in the non-CVC group (P＜0.01).
    Conclusions Age, dialysis duration, the primary disease, calcium and phosphate, and inflammation- and nutrition-related serum indicators are associated with CVC in MHD patients. CVC significantly increases mortality risk of MHD patients.

     

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