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目的:探讨维持性血液透析(MHD)患者心血管钙化进展的影响因素。方法:选择MHD>6月的患者104例,完善相关实验室检查,胸部螺旋CT检测冠状动脉钙化评分(CACS,Agston法),腹部侧位平片检测腹主动脉钙化评分(AACS,Kauppila法),心脏超声检测心脏瓣膜钙化情况。随访观察3年,探讨心血管钙化进展情况及其影响因素。结果:随访基线时钙化总阳性率为69.23%,随访3年后钙化总阳性率升至81.18%,CACS、AACS、心脏瓣膜钙化均较基线明显加重。Logistic回归分析显示舒张早期和舒张晚期二尖瓣口最大血液速度之比(E/A值)、时间平均血磷、时间平均钙磷乘积、基线CACS、碳酸钙的使用均是CACS进展的独立危险因素(P<0.05)。研究期间17例(16.34%)患者死亡,因心脑血管疾病死亡患者基线钙化情况更为严重。结论:MHD患者心血管钙化发生率高,且随透析时间延长逐年加重,临床血磷、钙磷乘积等指标控制达标情况及基线CAC等均影响远期CAC进展。
Objective: To investigate the influencing factors of cardiovascular calcification in patients with maintenance hemodialysis (MHD). Methods: A total of 104 patients with MHD> 6 months were enrolled in this study. The relevant laboratory tests were completed. The coronary artery calcification score (CACS, Agston method) was detected by chest spiral CT and the abdominal aorta calcification score (AACS, Kauppila method) Cardiac echocardiography detects heart valve calcification. Follow-up observed for 3 years to explore the progress of cardiovascular calcification and its influencing factors. Results: The total positive rate of calcification was 69.23% at follow-up. The total positive rate of calcification increased to 81.18% after 3 years of follow-up. CACS, AACS and heart valve calcification were significantly worse than baseline. Logistic regression analysis showed that the ratio of E / A, EMPA, time-averaged phosphorus, time-averaged calcium-phosphorus product, baseline CACS, calcium carbonate use were independent risk factors for CACS progression in early diastole and late diastole Factor (P <0.05). Seventeen patients (16.34%) died during the study period. The baseline calcification was worsened due to cardiovascular and cerebrovascular diseases. Conclusion: The incidence of cardiovascular calcification in patients with MHD is high, and with the prolongation of dialysis time increased year by year, clinical phosphorus and calcium phosphorus product control indicators such as compliance and baseline CAC affect the long-term CAC progress.