论文部分内容阅读
目的观察终末期肾病维持性血液透析(MHD)患者心脏瓣膜钙化(VC)的发病情况并对相关危险因素进行分析。方法对稳定透析6个月以上的MHD患者96例使用HP-550型彩色超声诊断仪进行心脏VC情况检测,将患者分为VC组与无VC组,比较二组患者的年龄、性别、透析时间、吸烟、血压、糖尿病肾病、SGA评分、血清白蛋白(Alb)、前白蛋白(pA)、血脂、血钙、血磷、钙磷乘积、全段甲状旁腺激素(iPTH)以及心脏室间隔厚度(IVS)、左室舒张期内径(LVID)、射血分数(EF)和左室肥厚(LVH)的发生率等指标。结果 96例MHD患者中34例(35.42%)发生VC。VC组透析时间显著长于无VC组,中重度营养不良的发生率、钙磷乘积明显增高(>4.43 mmol2/L2)者、CRP、室间隔厚度(IVS)、左室舒张期内经(LVID)、左室肥厚(LVH)发生率等均显著高于无VC组,此外,血清白蛋白(Alb)、前白蛋白(PA)、EF显著低于无VC组,吸烟、高血压、糖尿病、血脂异常、血钙、血磷、iPTH等指标二组比较差异无统计学意义,但是二组患者的iPTH显著高于正常人群。结论钙磷乘积增高,甲状旁腺功能亢进、炎症、营养不良等均为MHD患者VC发生的危险因素。VC发生后,MHD患者更容易出现心脏结构和功能改变。
Objective To observe the incidence of heart valve calcification (VC) in patients with end-stage renal disease (MHD) and to analyze the related risk factors. Methods Ninety-six MHD patients with stable dialysis for more than 6 months were enrolled in this study. The heart VC was detected by HP-550 color ultrasound system. The patients were divided into VC group and non-VC group. The age, sex, dialysis time , Smoking, blood pressure, diabetic nephropathy, SGA score, serum albumin (Alb), prealbumin (pA), serum lipids, serum calcium, phosphorus, calcium and phosphorus products, total parathyroid hormone (iPTH) (IVS), left ventricular diastolic diameter (LVID), ejection fraction (EF) and left ventricular hypertrophy (LVH) incidence and other indicators. Results Of 96 MHD patients, 34 (35.42%) patients developed VC. The dialysis duration in VC group was significantly longer than that in non-VC group. The incidence of moderate-severe malnutrition, calcium-phosphorus product was significantly higher (> 4.43 mmol2 / L2), CRP, IVS, LVID, The incidence of left ventricular hypertrophy (LVH) was significantly higher than that of no VC group. In addition, serum albumin (Alb), prealbumin (PA) and EF were significantly lower than those without VC, smoking, hypertension, diabetes, dyslipidemia , Serum calcium, phosphorus, iPTH and other indicators of the two groups showed no significant difference between the two groups, but the two groups of iPTH was significantly higher than the normal population. Conclusions Increased calcium and phosphorus products, hyperparathyroidism, inflammation and malnutrition are the risk factors for VC in patients with MHD. After the occurrence of VC, MHD patients are more prone to changes in cardiac structure and function.