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目的:动态观察腹膜透析(PD)患者心血管钙化的患病率和演变情况,分析影响钙化的因素及临床意义。方法:前瞻性观察150例PD患者,评估基线临床特征及心血管钙化的患病率,随访30个月,分别于第0、12和24个月评估钙化的影像学演变。Logistic回归分析影响心血管钙化及进展的相关因素;计算患者的全因或心血管疾病(CVD)死亡率和非致死性心血管事件(CVE)的发生率,分析相关危险因素。结果:基线时57.3%的患者存在钙化,至随访结束,心血管钙化率升至63.2%,53.5%(61/114)的患者观察到钙化进展。随访中5.3%(8/150)患者死亡,最常见的死因是CVD(75%),CVE的发生率为19.3%。有临床意义钙化患者的全因死亡(P=0.004)和CVD死亡显著高于其他患者(P=0.002)。低蛋白血症及二尖瓣钙化是全因死亡和CVD死亡的独立危险因素;年龄>46岁、低密度脂蛋白胆固醇及冠状动脉钙化+心瓣膜钙化是CVE的独立危险因素。结论:PD患者合并心血管钙化的患病率较高,病变进展较快,与CVD的发生有着密切的联系,心血管钙化对整体预后产生不良影响。
Objective: To dynamically observe the prevalence and evolution of cardiovascular calcification in patients undergoing peritoneal dialysis (PD) and analyze the factors influencing calcification and its clinical significance. Methods: A prospective study of 150 patients with PD was performed to assess the baseline clinical features and the prevalence of cardiovascular calcification. The follow-up of 30 months was performed to evaluate the imaging changes of calcifications at 0, 12 and 24 months respectively. Logistic regression analysis was used to analyze the factors influencing cardiovascular calcification and progression; the incidence of all-cause or cardiovascular disease (CVD) mortality and non-fatal cardiovascular events (CVE) were calculated and risk factors were analyzed. Results: At baseline, 57.3% of patients had calcification. At the end of follow-up, cardiovascular calcification rates rose to 63.2%, and calcification was observed in 53.5% (61/114) of patients. At follow-up, 5.3% (8/150) of the patients died. The most common cause of death was CVD (75%) and CVE was 19.3%. All-cause mortality (P = 0.004) and CVD death in patients with clinically significant calcification were significantly higher than those in other patients (P = 0.002). Hypoproteinemia and mitral valve calcification were independent risk factors for all-cause mortality and CVD death. Low-density lipoprotein cholesterol, coronary artery calcification and cardiac valve calcification were independent risk factors for CVE at the age of 46 years. Conclusion: The prevalence of cardiovascular calcification in patients with PD is high, and the progression of the disease is rapid. It is closely related to the occurrence of CVD, and cardiovascular calcification has an adverse effect on the overall prognosis.