慢性肾脏病腹膜透析患者血脂水平与冠状动脉钙化严重程度的关系被引量：1

The relationship between the level of blood lipid and the severity of coronary artery calcification in peritoneal dialysis patients with chronic kidney disease

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摘要 [目的]探讨慢性肾脏病(CKD)腹膜透析(PD)患者血脂水平与冠状动脉钙化(CAC)严重程度的关系。[方法]选取2018年6月—2021年12月本院收治的205例进行PD治疗的CKD患者作为研究对象,根据CAC评分将患者分为钙化组(n=152)和未钙化组(n=53),并将钙化组分为轻度钙化组(n=61)、中度钙化组(n=50)和重度钙化组(n=41),采用单因素分析比较患者临床资料及实验室指标差异;采用限制性三次样条拟合Logistic回归模型分析血脂水平与CAC的关系;采用多元Logistic回归模型分析影响因素,并绘制受试者工作特征(ROC)曲线探讨血脂水平对CAC严重程度的预测价值。[结果]与未钙化组相比,钙化组年龄、糖尿病比例、体质指数(BMI)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDLC)、血磷水平显著增加,血尿酸(UA)、高密度脂蛋白胆固醇(HDLC)、血镁、25-羟维生素D3(25-(OH)-VitD3)水平显著降低(P<0.05);Logistic回归显示,调整年龄、糖尿病等因素后TC(OR=1.79,95%CI:1.56~2.10)、TG(OR=2.13,95%CI:1.86~2.41)、HDLC(OR=0.67,95%CI:0.42~0.84)、LDLC(OR=2.01,95%CI:1.78~2.32)仍是CAC发生的危险因素,且随着TG、TC、LDLC水平升高,HDLC水平降低,其关联效应值也相应增高(P趋势<0.05);与轻度钙化组相比,中度钙化组、重度钙化组年龄、TG、TC均显著增加,HDLC均显著降低,中度钙化组UA显著增加,重度钙化组LDLC、血磷显著增加,血镁、25-(OH)-VitD3显著降低;与中度钙化组相比,重度钙化组TC、LDLC显著增加,UA、HDLC显著降低(均P<0.05),且多元Logistic回归模型表明高龄,TG、TC、LDLC水平升高及HDLC水平降低是CKD患者PD治疗后发生重度CAC的独立危险因素(均P<0.05);限制性三次样条回归分析表明血脂水平与CAC严重程度呈明显的相关性;ROC曲线分析显示,血TG、TC、HDLC、LDLC联合检测的AUC为0.897,灵敏度为0.899,特异度为0.826,表明TG、TC、HDLC、LDLC联合检测对进行PD治疗的CKD患者CAC严重� Aim To investigate the correlation between blood lipid level and the severity of coronary artery calcification(CAC)in peritoneal dialysis(PD)patients with chronic kidney disease(CKD).Methods 205 CKD patients treated with PD in our hospital from June 2018 to December 2021 were selected as the study subjects,according to the CAC scores,they were divided into calcified group(n=152)and non-calcified group(n=53),and the patients in calcified group were divided into mild calcification group(n=61),moderate calcification group(n=50),and severe calcification group(n=41).The differences in clinical data and laboratory indicators were compared through univariate analysis.The restricted cubic spline fitting Logistic regression model was used to analyze the relationship between blood lipid levels and CAC.Multiple Logistic regression model was used to analyze the influencing factors,receiver operating characteristic(ROC)curve was drawn to explore the predictive value of blood lipid levels for the severity of CAC.Results Compared with the non-calcified group,the age,diabetes ratio,body mass index(BMI),triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDLC),and blood phosphorus levels increased significantly in the calcified group,the levels of uric acid(UA),high density lipoprotein cholesterol(HDLC),blood magnesium,and 25-hydroxyvitamin D3(25-(OH)-VitD3)were significantly reduced(P<0.05);Logistic regression showed that adjusted TC(OR=1.79,95%CI:1.56~2.10),TG(OR=2.13,95%CI:1.86~2.41),HDLC(OR=0.67,95%CI:0.42~0.84),LDLC(OR=2.01,95%CI:1.78~2.32)were still a risk factor for the occurrence of CAC after adjusting for age,diabetes and other factors,and as the levels of TG,TC,and LDLC increased,the levels of HDLC decreased,and their correlation effect values also increased correspondingly(Ptrend<0.05).Compared with the mild calcification group,the age,TG,and TC of the moderate and severe calcification groups significantly increased,HDLC significantly decreased,UA significantly increased in the moderate calcifica

作者王树龙王云尚瑞华鲍妍韩惠淑刘向东 WANG Shulong;WANG Yun;SHANG Ruihua;BAO Yan;HAN Huishu;LIU Xiangdong(Department of Nephrology,the First Affiliated Hospital of Xinxiang Medical College,Weihui,Henan 453100,China)

机构地区新乡医学院第一附属医院肾病内科

出处《中国动脉硬化杂志》 CAS 2024年第1期31-39,共9页 Chinese Journal of Arteriosclerosis

基金河南省医学科技攻关计划联合共建项目(LHGJ2022591)。

关键词慢性肾脏病腹膜透析血脂水平冠状动脉钙化 chronic kidney disease peritoneal dialysis blood lipid level coronary artery calcification

分类号 R5 [医药卫生—内科学]