尿毒症非透析患者心瓣膜钙化危险因素分析
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广州市番禺区科技局资助项目(2007Z791)


Analysis of Risk Factors of Cardiac Valve Calcification in NonDialysis Uremic Patients
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    摘要:

    目的探讨尿毒症非透析患者心脏瓣膜钙化的临床相关危险因素及胎球蛋白A与心瓣膜钙化的关系。方法通过彩色多普勒超声心动图检查观察88例尿毒症非透析患者心脏瓣膜钙化的情况,根据心脏彩超结果将其分为瓣膜钙化组和未钙化组。收集患者的血生化指标,放射免疫法测定全段甲状旁腺激素(iPTH);同时选择我院体检中心健康体检者30例为正常对照组,ELISA法测定研究组及对照组血清胎球蛋白A。采用二分类Logistic回归方法分析瓣膜钙化的危险因素。结果88例患者中发现心脏瓣膜钙化25例,其中主动脉瓣钙化(AVC)21例,二尖瓣钙化(MVC)4例,联合瓣膜钙化2例;研究组胎球蛋白A水平明显低于对照组;瓣膜钙化组患者的年龄、血磷、钙磷乘积、C反应蛋白、iPTH明显高于未钙化组,胎球蛋白A水平明显低于未钙化组(P<0.05),Logistic回归分析显示年龄(B=3732,P=0.015)、炎症(B=1503,P=0.025)、血磷(B=1774,P=0.003)、钙磷乘积(B=1255,P=0.003)、血iPTH(B=0.832,P=0.017)是心脏瓣膜钙化的危险因素,胎球蛋白A是心脏瓣膜钙化的抑制剂(B=-0.59,P=0.043);直线相关分析显示胎球蛋白A与CRP呈负相关(r=-0.545,P=0.000) 。结论尿毒症非透析患者心脏瓣膜钙化的发生率高,以主动脉瓣钙化多见。年龄、炎症、高磷、高钙磷乘积、血iPTH是瓣膜钙化的危险因素。胎球蛋白A是瓣膜钙化的抑制剂,胎球蛋白A水平与CRP呈负相关。

    Abstract:

    AimTo investigate the risk factors of cardiac valve calcification in non-dialysis uremic patients.MethodsEchocardiographic examination was performed to detect the calcificaion in 88 non-dialysis uremic patients.Patients were divided into two groups based on the echocardiographic, one as valve calcification, and the other as valve non-calcification.The blood biochemical indicators were collected, serum parathyroid hormone (iPTH) was detected by radioimmunology.Thirty healthy cases were selected for normal control group.Serum fetuin-A was measured by enzyme-linked immunosorbnent assay (ELISA) in both of the study group and control group.The calcification risk factors were analyzed by binary logistic regression.ResultsOf the 88 patients studied, cardiac valve calcification was found in 25 patients, aortic valve calcification in 21 patients, mitral valve calcification in 4 patients, aortic and mitral valve calcification in 2 patients.Serum fetuin-A was lower in study group than in normal control group(P<0.05).Age, serum phosphorus, calcium phosphorus product(Ca×P), C-reaction protein (CRP) and iPTH were higher in calcification group than in non-calcifiation group,while serum fetuin-A was lower (P<0.05).Binary Logistic regression analysis showed that age (B=3732, P=0.015), Ca×P (B=1255, P=0.003), P (B=1774, P=0.003), CRP (B=1503, P=0.025) and iPTH (B=0.832, P=0.017) were the risk factors of cardiac valve calcification.Fetuin-A (B=-0.59, P=0.043) was negatively correlated with cardiac valve calcification.Fetuin-A was negatively correlated with CRP (r=-0.545, P=0.000).ConclusionsThe cardiac valve calcification is prevalent in non-dialysis uremic patients, of which aortic valve calcification is more common than mitral valve calcification.The risk factors include age, Ca×P, P, inflammation, iPTH.Serum fetuin-A is the valve calcification inhibitors and negatively correlated with CRP.

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陈小妹,张道友.尿毒症非透析患者心瓣膜钙化危险因素分析[J].中国动脉硬化杂志,2012,20(12):1129~1132.

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  • 收稿日期:2012-05-24
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