上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

腹主动脉钙化对维持性血液透析患者预后的评估价值

李璐瑶，戴慧莉，张敏芳，方燕，倪兆慧   

  1. 上海交通大学 医学院附属仁济医院肾脏内科， 上海 200127
  • 出版日期:2016-07-28 发布日期:2016-08-31
  • 作者简介:李璐瑶（1989—）， 女， 硕士生; 电子信箱: liluyaojd@163.com。

Value of abdominal aortic calcification for evaluating the prognosis of patients undergoing maintenance hemodialysis

LI Lu-yao, DAI Hui-li, ZHANG Min-fang, FANG Yan, NI Zhao-hui   

  1. Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2016-07-28 Published:2016-08-31

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摘要：

目的 探讨腹主动脉钙化（AAC）对维持性血液透析（MHD）患者预后的评估价值。方法 入选我院MHD患者164例，通过腹部侧位平片检测腹主动脉的钙化情况，根据是否发生钙化将患者分为AAC组和非AAC组。并对这些患者进行为期（54.51±13.80）个月的随访。结果 164例MHD患者中，113例（68.90%）发生AAC。随访期间，32名患者（19.51%）死亡，其中有22人（13.41%）死于心血管疾病（CVD）。Kaplan-Meier分析显示AAC组的全因死亡率和CVD死亡率显著高于非AAC组（24.8% vs 7.8%, P=0.013; 18.6% vs 2.0%, P=0.004)。多因素COX回归模型显示：AAC、年龄和白蛋白是MHD患者全因死亡的独立危险因素，AAC和年龄是MHD患者CVD死亡的独立危险因素。受试者工作特征（ROC）曲线显示：AAC预测MHD患者全因死亡及CVD死亡的价值较高，曲线下面积（AUC）分别为0.719（95%CI 0.617～0.821，P=0.000)和0.743（95%CI 0.640～0.847，P=0.000)。结论 MHD患者中AAC的发生率较高，AAC患者的全因死亡率及CVD死亡率明显高于非AAC患者，AAC对MHD患者的预后可能具有良好的评估价值。

关键词: 血液透析, 腹主动脉钙化, 预后, 心血管疾病

Abstract:

Objective To investigate the value of abdominal aortic calcification (AAC) for evaluating the prognosis of patients undergoing maintenance hemodialysis (MHD). Methods 164 patients were enrolled and their AAC was evaluated with abdominal lateral plain radiography. Patients were assigned to the AAC group and the non-AAC group according to whether AAC was presented and were followed up for a period of (54.51±13.80) months. Results Of 164 patients undergoing MHD, 113 (68.90%) developed AAC. Of 32 patients died (19.51%) during follow up period, 22 (13.41%) died from cardiovascular disease (CVD). Kaplan-Meier analyses showed that the all-cause mortality and the CVD mortality were significantly higher in the AAC group than in the non-AAC group (24.8% vs 7.8%, P=0.013; 18.6% vs 2.0%, P=0.004). Multivariate Cox proportional hazards analyses indicated that AAC, age, and albumin were independent risk factors for the all-cause mortality, while AAC and age were independent risk factors for the CVD mortality. Receiver operating characteristic (ROC) curves suggested that AAC had a higher value for predicting the all-cause mortality and the CVD mortality with areas under curves (AUC) of 0.719 (95%CI 0.617-0.821，P=0.000) and 0.743 (95%CI 0.640-0.847，P=0.000), respectively. Conclusion The incidence of AAC is higher in patients undergoing MHD. The all-cause mortality and the CVD mortality are significantly higher in patients with AAC than in patients without AAC. AAC has a favorable value for evaluating the prognosis of patients undergoing MHD.

Key words: hemodialysis, abdominal aortic calcification, prognosis, cardiovascular disease