摘要
目的探讨影响维持性血液透析（MHD）患者冠状动脉钙化（CAC）的相关危险因素，观察硫代硫酸钠（STS）对CAC进展的干预作用及其安全性。方法通过螺旋CT对2013年12月至2014年12月福州总医院38例MHD患者进行CAC积分以评估冠状动脉的钙化情况。依据CAC积分结果分为CAC组（CAC积分〉10分，27例）和无钙化组（CAC积分≤10分，11例），比较两组年龄、透析龄和血清学指标的差异，分析影响血管钙化的相关危险因素。进一步将CAC积分≥50分的患者随机分为两组，一组患者常规治疗3个月（常规治疗组），另一组患者在血液透析结束后接受STS（0.18 g/kg）静脉滴注治疗，3次/周，为期3个月（STS治疗组）。两组治疗前的相关基线资料比较差异无统计学意义。比较两组血管钙化患者治疗前后影像学、CAC积分、生化及骨密度等相关指标的改变情况，并观察STS治疗过程中的不良反应。本研究通过福州总医院伦理委员会批准（2013No1）。结果38例MHD患者中有27例（71.05%）患者冠状动脉发生钙化，CAC组的年龄、透析龄、血磷、钙磷乘积、全段甲状旁腺素和超敏C反应蛋白水平显著高于无钙化组（P＝0.017，0.037，0.038，0.037，0.012，0.002），而其白蛋白水平低于无钙化组（P＝0.026）。STS治疗组CAC积分治疗前后差异无统计学意义[1 045（47～12 734）比797（50～14 094），P＝0.053]，而常规治疗组CAC积分显著增加，差异有统计学意义[221（59～3 843）比174（50～3 369），P＝0.021]；STS治疗组与常规治疗组治疗前后CAC积分差值[－67.5（－474～8）比52（－248～1 361）]差异有统计学意义（P＝0.004）。STS治疗后超敏C反应蛋白水平降低（P＝0.016），HCO3－水平降低（P＝0.020），血钙水平升高（P＝0.005）。结论STS治疗，可能延缓患者动脉钙化的进展，减轻炎症反应，治疗过程中无严重不良反应。
Objective To investigate the factors correlated to coronary artery calcification （CAC）in maintenance hemodialysis （MHD） patients and observe the effect of sodium thiosulfate （STS） on the progression of vascular calcification and its safety.Methods Thirty-eight subjects from Fuzhou Genernal Hospital who underwent coronary artery CT scan using Philip′s spiral CT were enrolled and the calcification degree was evaluated by CAC scores from December 2013 to December 2014. The hemodialysis patients were divided into CAC group （CAC scores〉10, 27 cases） and non-CAC group （CAC scores≤10, 11 cases）according to the CT scan results.The differences of age, duration of dialysis, blood pressure and other hematological indices between the two groups were analyzed to investigate the factors correlated to CAC. Next, those with CAC （CAC scores≥50） received intravenous 0.18 g/kg STS （dissolved in 100 ml saline） in 30 minutes after each dialysis for 3 months （n=17, only 15 patients completed STS treatment） or received conventional treatment （n=10）. Baseline data between the two groups before treatment had no significant statistical difference. All examination indices were evaluated before and after the treatment course. The changes of vascular calcification imaging, CAC scores, biochemical indices and bone mineral density were compared between two groups before and after the treatment. Besides, adverse reactions were observed during the treatment of STS. This study was approved by the Ethics Committee of Fuzhou General Hospital（2013No1）.Results Twenty-seven out of 38 patients （71.05%） had CAC, and the patients with CAC had significantly higher age, phosphate, the product of calcium and phosphate, intact parathyroid hormone （hPTH）, hypersensitive C-reactive protein （hsCRP）, and longer duration of dialysis （P=0.017, 0.038, 0.037, 0.012, 0.002, 0.037） and lower serum albumin （P=0.026） than patients without CAC.There was no significant statistical difference in the baseli
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第46期3724-3728,共5页
National Medical Journal of China
基金
福建省科技计划重点项目（2013Y0069）
