摘要
目的探讨终末期肾病(ESRD)患者心脏瓣膜钙化(CVC)特点及其与25-羟维生素D[25(OH)D]缺乏的相关性。方法纳入于我院治疗的ESRD患者,采用超声心动图评估主动脉瓣钙化(AVC)和二尖瓣钙化(MVC)情况,根据是否存在CVC、AVC、MVC,将所有患者分别分为CVC组和非CVC组、AVC组和非AVC组、MVC组和非MVC组,并分别比较其临床资料。采用多因素logistic回归分析评估ESRD患者CVC的影响因素;采用受试者工作特征(ROC)曲线评估25(OH)D对ESRD患者CVC的预测价值。结果共纳入657例ESRD患者,CVC的发生率为55.9%,其中AVC占42.8%,MVC占24.0%;25(OH)D缺乏的发生率为69.6%。CVC组年龄、透析龄、Hb、超敏C反应蛋白(hs-CRP)、血磷、全段甲状旁腺激素(iPTH)水平及高龄、透析治疗、冠心病、糖尿病、AAC、25(OH)D缺乏患者比例均高于非CVC组,Alb及25(OH)D水平均低于非CVC组(P<0.05)。AVC组年龄、透析龄、Hb、hs-CRP、血磷、iPTH水平及高龄、透析治疗、冠心病、糖尿病、AAC、25(OH)D缺乏患者比例均高于非AVC组,Alb及25(OH)D水平均低于非AVC组(P<0.05)。MVC组女性、高龄、透析治疗、冠心病、糖尿病、AAC、25(OH)D缺乏患者比例及年龄、透析龄、hs-CRP、血磷、iPTH、低密度脂蛋白胆固醇(LDL-C)水平均高于非MVC组,Alb及25(OH)D水平均低于非MVC组(P<0.05)。多因素logistic回归分析结果显示,年龄、透析龄、冠心病、糖尿病、hs-CRP、血磷、iPTH、AAC是ESRD患者CVC的独立危险因素,Alb、25(OH)D是其独立保护因素(P<0.05)。ROC曲线分析结果显示,25(OH)D预测ESRD患者CVC的ROC曲线下面积为0.722(95%CI 0.681~0.763,P<0.001),最佳截断值为12.8 ng/ml,敏感度为72.3%,特异度为76.4%。结论ESRD患者AVC与MVC的相关因素各有异同,25(OH)D缺乏是ESRD患者CVC的独立危险因素。
Objective To explore characteristic of cardiac valve calcification(CVC)and its association with 25-hydroxy vitamin D[25(OH)D]deficiency in patients with end stage renal disease(ESRD).Methods Patients with ESRD who were treated in our hospital were enrolled.Aortic valve calcification(AVC)and mitral valve calcification(MVC)condition were assessed by echocardiography.According to the existence of CVC,AVC and MVC or not,all patients were divided into CVC group and non-CVC group,AVC group and non-AVC group,MVC group and non-MVC group respectively,and clinical data were compared.Multivariate logistic regression analysis was used to evaluate influencing factors of CVC in patients with ESRD.Predictive value of 25(OH)D for CVC in patients with ESRD was evaluated by receiver operating characteristic(ROC)curve.Results A total of 657 patients with ESRD were enrolled,and the incidence of CVC was 55.9%,of which AVC accounted for 42.8%and MVC accounted for 24.0%.The incidence of 25(OH)D deficiency was 69.6%.Age,dialysis age,Hb,hypersensitive C reactive protein(hs-CRP),serum phosphorus,complete parathyroid hormone(iPTH)levels and proportion of patients with elderly,dialysis therapy,coronary heart disease,diabetes mellitus,AAC,25(OH)D deficiency in CVC group were higher than those in non-CVC group,Alb and 25(OH)D levels were lower than those of non-CVC group(P<0.05).Age,dialysis age,Hb,hs-CRP,serum phosphorus,iPTH levels and proportion of elderly,dialysis therapy,coronary heart disease,diabetes mellitus,AAC,25(OH)D deficiency in AVC group were higher than those in non-AVC group,Alb and 25(OH)D levels in AVC group were lower than those in non-AVC group(P<0.05).Proportion of female,elderly,dialysis therapy,coronary heart disease,diabetes mellitus,AAC,25(OH)D deficiency,age,dialysis age,hs-CRP,serum phosphorus,iPTH,low density lipoprotein cholesterol(LDL-C)levels in MVC group were higher than those in non-MVC group,Alb and 25(OH)D levels were lower than those in non-MVC group(P<0.05).Multivariate logistic regression analysis showed
作者
生玉平
马晓迎
杨星梦
刘烨
孙福云
Sheng Yuping;Ma Xiaoying;Yang Xingmeng;Liu Ye;Sun Fuyun(Department of Nephrology,Cangzhou Central Hospital,Cangzhou 061000,China)
出处
《临床内科杂志》
CAS
2024年第3期170-174,共5页
Journal of Clinical Internal Medicine
基金
沧州市重点研发计划指导项目(204106081)
河北省卫生健康委员会科研基金资助项目(20220332)。
关键词
终末期肾病
心脏瓣膜钙化
25-羟维生素D
End stage renal disease
Cardiac valve calcification
25-hydroxyvitamin D
