本文選題：維持性血液透析 + 腹主動(dòng)脈鈣化�。� 參考：《腎臟病與透析腎移植雜志》2017年05期

【摘要】：目的:調(diào)查維持性血液透析(MHD)患者腹主動(dòng)脈鈣化(AAC)的發(fā)生率,分析影響AAC發(fā)生的危險(xiǎn)因素,尤其是血清25羥維生素D_3[25(OH)D_3]水平與AAC之間的相關(guān)性。方法:選取2015年12月至2016年12月在哈爾濱醫(yī)科大學(xué)第一附屬醫(yī)院血液凈化中心進(jìn)行MHD患者,共182例,記錄患者相關(guān)臨床和實(shí)驗(yàn)室資料,腰椎側(cè)位X線片檢測(cè)患者腹主動(dòng)脈鈣化情況,并進(jìn)行半定量評(píng)分。根據(jù)患者是否檢出AAC分為鈣化組與非鈣化組,比較兩組患者血清25(OH)D_3水平及各項(xiàng)臨床指標(biāo)差異,多因素logistic回歸法分析影響患者AAC發(fā)生的危險(xiǎn)因素,并用Spearman相關(guān)法分析血清25(OH)D_3水平與AAC評(píng)分的相關(guān)性。結(jié)果:鈣化組144例(79.1%),非鈣化組38例(20.9%),鈣化組患者25(OH)D_3水平顯著低于非鈣化組[(26.55±20.53)ng/m L比(46.1±26.11)ng/m L,P0.01]。鈣化組患者的年齡、透析齡、患有糖尿病、磷、鈣磷乘積、堿性磷酸酶(AKP)、全段甲狀旁腺激素(i PTH)、總膽固醇(TC)均明顯高于非鈣化組(P0.05)。24h殘余尿量、25(OH)D_3、舒張壓均明顯低于非鈣化組(P0.05)。多因素logistic回歸分析顯示:年齡、體質(zhì)量指數(shù)(BMI)、患有糖尿病、磷、i PTH、TC可能是發(fā)生AAC的危險(xiǎn)因素。24h殘余尿量、25(OH)D_3為保護(hù)性因素。Spearman相關(guān)分析顯示,MHD患者血清25(OH)D_3水平與AAC評(píng)分之間呈負(fù)相關(guān)。結(jié)論:MHD患者AAC發(fā)生率高,AAC的發(fā)生與年齡、BMI、患有糖尿病、磷、i PTH、TC有關(guān),而24h殘余尿量和25(OH)D_3是保護(hù)性因素,血清25(OH)D_3水平與AAC評(píng)分呈負(fù)相關(guān)。
[Abstract]:Aim: to investigate the incidence of abdominal aortic calcification in patients with maintenance hemodialysis (HD) and analyze the risk factors affecting the occurrence of AAC, especially the correlation between serum 25 hydroxyvitamin D 3 [25(OH)D_3] and AAC. Methods: from December 2015 to December 2016, 182 patients with MHD were enrolled in the blood purification center of the first affiliated Hospital of Harbin Medical University. The clinical and laboratory data of the patients were recorded. The calcification of abdominal aorta was detected by lateral X-ray of lumbar vertebrae and semi-quantitative score was performed. Patients with AAC were divided into calcified group and non-calcified group according to whether they were detected. The serum 25(OH)D_3 levels and clinical indexes were compared between the two groups. The risk factors affecting the occurrence of AAC were analyzed by multivariate logistic regression. The correlation between serum 25(OH)D_3 level and AAC score was analyzed by Spearman correlation method. Results: there were 144 cases in calcified group and 38 cases in non-calcified group. The 25(OH)D_3 level in calcified group was significantly lower than that in non-calcified group [26.55 鹵20.53)ng/m / L vs 46.1 鹵26.11)ng/m / L P0.01]. The age, dialysis age, diabetes mellitus, phosphorus, calcium and phosphorus product, alkaline phosphatase (ALP), whole parathyroid hormone (PTH), total cholesterol (TCC) in calcified group were significantly higher than those in non-calcified group (P 0.05, 24 h), and diastolic blood pressure was significantly lower than that in non-calcified group (P 0.05). Multivariate logistic regression analysis showed that age, body mass index (BMI), diabetes mellitus (DM), The correlation analysis of serum 25(OH)D_3 level and AAC score showed that the serum 25(OH)D_3 level was negatively correlated with the AAC score in patients with AAC, and the 24 h residual urine volume was 25 OHH / D3 as a protective factor .Spearman correlation analysis showed that there was a negative correlation between serum 25(OH)D_3 level and AAC score in patients with AAC. Conclusion the incidence of AAC in patients with AAC is higher than that in controls. The incidence of AAC is related to the age of BMI, diabetes mellitus, and PTH TC, while 24 h residual urine volume and 25(OH)D_3 are protective factors, and the serum 25(OH)D_3 level is negatively correlated with the AAC score. [WT5HZ] [WT5 "HZ] [WT5" BZ] [WT5 "BZ]
【作者單位】： 哈爾濱醫(yī)科大學(xué)附屬第一醫(yī)院腎內(nèi)科二病房;
【基金】：教育部博士點(diǎn)基金課題(20122307110011)
【分類號(hào)】：R459.5

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