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110例维持性血液透析患者血管钙化的发生情况及影响因素分析

Occurrence and risk factors of vascular calcification in 110 maintenance hemodialysis patients

    摘要
  • 摘要:
    目的 观察行维持性血液透析治疗慢性肾衰竭(CRF)患者的血管钙化发生情况，并分析相关影响因素。
    方法 选取在河北省邢台市中心医院行维持性血液透析治疗的110例CRF患者为研究对象。通过髋关节、腹部及双手X线片检查明确患者是否存在血管钙化，并根据钙化结果将患者分为钙化组(n=59, 轻、中、重度钙化)与非钙化组(n=51，无钙化)。比较2组一般资料和实验室指标白细胞(WBC)计数、血红蛋白(Hb)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、白蛋白(ALB)、血钾(K)、血钙(Ca)、血磷(P)、血肌酐(SCr)、尿素氮(BUN)、尿酸(UA)、全段甲状旁腺激素(iPTH)、超敏C反应蛋白(hs-CRP)、白细胞介素-13(IL-13)、成纤维细胞生长因子23(FGF23)、骨硬化蛋白(SOST), 并通过Logistic回归分析筛选血管钙化的影响因素。
    结果 钙化组与非钙化组在性别、体质量指数、吸烟史及肾脏原发病方面比较，差异均无统计学意义(P>0.05)。钙化组平均年龄、透析龄高于非钙化组，差异有统计学意义(P < 0.05)。钙化组与非钙化组WBC、Hb、TC、TG、HDL-C、LDL-C、K、Ca、BUN水平比较，差异均无统计学意义(P>0.05)。与非钙化组相比，钙化组ALB、UA水平更低，P、SCr、iPTH、hs-CRP、IL-13、FGF23及SOST水平更高，差异有统计学意义(P < 0.05)。多因素Logistic回归分析显示，年龄、透析龄以及P、iPTH、IL-13、FGF23和SOST水平均是患者发生血管钙化的影响因素(P < 0.05)。受试者工作特征曲线显示，IL-13、FGF23、SOST对患者血管钙化均有一定的诊断价值曲线下面积(AUC)均>0.7, 且IL-13、FGF23、SOST联合诊断的效能高于三者单独诊断(AUC=0.911, P < 0.05)。
    结论 血管钙化在行维持性血液透析治疗的CRF患者中较常见，年龄、透析龄、P、IL-13、FGF23、SOST等是血管钙化的影响因素。

     

    Abstract:
    Objective To observe the incidence of vascular calcification in patients with chronic renal failure (CRF) undergoing maintenance hemodialysis and analyze the related influencing factors.
    Methods A total of 110 CRF patients undergoing maintenance hemodialysis at Xingtai Central Hospital in Hebei Province were selected. Vascular calcification was determined through hip, abdominal, and bilateral hand X-ray examinations, and patients were divided into calcification group (n=59, with mild, moderate, and severe calcification) and non-calcification group (n=51, without calcification) based on the calcification results. General information and laboratory indicators white blood cell (WBC) count, hemoglobin (Hb), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), albumin (LB), serum potassium (K), serum calcium (Ca), serum phosphorus (P), serum creatinine (SCr), urea nitrogen (BUN), uric acid (UA), intact parathyroid hormone (iPTH), high-sensitivity C-reactive protein (hs-CRP), interleukin-13 (IL-13), fibroblast growth factor 23 (FGF23), sclerostin (SOST)were compared between the two groups, and Logistic regression analysis was performed to screen influencing factors of vascular calcification.
    Results There were no statistically significant differences in gender, body mass index, smoking history, and primary renal diseases between the calcification and non-calcification groups(P>0.05). The mean age and dialysis duration were higher in the calcification group compared to the non-calcification group (P < 0.05). There were no statistically significant differences in WBC, Hb, TC, TG, HDL-C, LDL-C, K, Ca, and BUN levels between the two groups (P>0.05). Compared with the non-calcification group, the calcification group had lower ALB and UA levels and higher P, SCr, iPTH, hs-CRP, IL-13, FGF23, and SOST levels(P < 0.05). Multivariate Logistic regression analysis showed that age, dialysis duration, and levels of P, iPTH, IL-13, FGF23, and SOST were influencing factors for vascular calcification in patients (P < 0.05). The receiver operating characteristic curve indicated that IL-13, FGF23, and SOST had certain diagnostic value for vascular calcification in patients area under the curve (AUC) >0.7, and the diagnostic efficacy of combined IL-13, FGF23, and SOST was higher than that of each indicator alone (AUC=0.911, P < 0.05).
    Conclusion Vascular calcification is common in CRF patients undergoing maintenance hemodialysis, and age, dialysis duration, P, IL-13, FGF23, and SOST are influencing factors for vascular calcification.

     

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