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目的探讨中晚期慢性肾脏病(chronic kidney disease,CKD)患者冠状动脉钙化的发生情况及影响因素。方法对上海交通大学医学院附属仁济医院的130例CKD3～5期患者进行冠脉多层螺旋CT(multi-slice spiral computed tomography,MSCT)检查,测定冠脉钙化分数(calcification score,CaS),收集患者的临床资料和相关生化检查指标,分析冠脉钙化的发生情况及其影响因素。结果中晚期CKD患者冠脉钙化发生率较高(74/130,56.9%),腹膜透析[143.9(0,662.9)]和血液透析[393.8(1.8,1491.0)]患者的冠脉CaS显著高于非透析患者[0(0,231.53)](P<0.01)。根据冠脉CaS是否为0分组后发现,有冠脉钙化组的年龄、既往心血管疾病发生率、糖尿病发生率、透析龄、空腹血糖、钙磷乘积和高敏C反应蛋白(highsensitive c-reactive protein,hsCRP)水平较无冠脉钙化组显著增高(P<0.05)。单因素相关分析显示冠脉CaS与患者的年龄(r=0.352,P<0.01)、空腹血糖(r=0.217,P<0.05)、透析龄(r=0.472,P<0.01)、钙磷乘积(r=0.183,P<0.05)和hsCRP(r=0.365,P<0.01)呈正相关。逐步多元线性回归分析显示年龄、透析龄和hsCRP水平是影响中晚期CKD患者冠脉钙化评分水平的独立危险因素(P<0.05)。结论中晚期CKD患者,特别是透析人群冠脉钙化发生率较高。年龄、透析龄和hsCRP水平与中晚期CKD患者冠脉钙化发生密切相关。
Objective To investigate the incidence and influencing factors of coronary artery calcification in patients with advanced stage kidney disease (CKD). Methods 130 patients with CKD stage 3-5 in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine were examined by multi-slice spiral computed tomography (MSCT), and the coronary calcification score (CaS) The clinical data of patients and related biochemical indexes were collected to analyze the incidence of coronary calcification and its influencing factors. Results The coronary CaS was significantly higher in advanced CKD patients (74 / 130,56.9%), peritoneal dialysis [143.9 (0,662.9)] and hemodialysis patients (393.8 (1.8,1491.0)] than in non-dialysis patients Patients [0 (0,231.53)] (P <0.01). According to coronary CaS is 0 group found that there was coronary artery calcification group, the incidence of previous cardiovascular disease, the incidence of diabetes, dialysis age, fasting blood glucose, calcium and phosphorus products and high-sensitive C-reactive protein (highsensitive c-reactive protein , hsCRP) were significantly higher than those without coronary artery calcification (P <0.05). Univariate correlation analysis showed that the relationship between coronary CaS and patient’s age (r = 0.352, P <0.01), fasting blood glucose (r = 0.217, P <0.05), dialysis age (r = 0.472, r = 0.183, P <0.05) and hsCRP (r = 0.365, P <0.01). Stepwise multivariate linear regression analysis showed that age, dialysis age and hsCRP level were independent risk factors influencing coronary calcium score in advanced CKD patients (P <0.05). Conclusions The incidence of coronary calcium is higher in patients with advanced CKD, especially in dialysis patients. Age, dialysis age and hsCRP levels are closely related to coronary calcium in patients with advanced CKD.