维持性血液透析患者腹主动脉钙化与左室重量指数、预后的关系及其影响因素分析

摘要 目的：研究维持性血液透析（MHD）患者腹主动脉钙化与左室重量指数（LVMI）、预后的关系及其影响因素。方法：将医院从2016年5月到2018年6月收治的182例MHD患者纳入研究。将所有患者按照腹主动脉钙化评分分为钙化组（腹主动脉钙化评分>0分）145例和非钙化组（腹主动脉钙化评分=0分）37例。分析比较两组LVMI、临床基线资料以及实验室检查指标水平的差异。采用多因素Logistic回归分析明确MHD患者腹主动脉钙化的影响因素。结果：钙化组LVMI明显高于非钙化组，差异有统计学意义（P＜0.05）。钙化组全因死亡率、心血管死亡率均高于非钙化组（P＜0.05）；且经Kaplan-Meier生存曲线分析发现：钙化组患者全因死亡累积生存率以及心血管死亡累积生存率均明显低于非钙化组（P＜0.05）。钙化组年龄、透析龄以及血磷、全段甲状旁腺激素水平均高于非钙化组，而25羟维生素D3水平低于非钙化组（P＜0.05）。经多因素Logistic回归分析发现：年龄、透析龄、血磷、全段甲状旁腺激素及LVMI均是MHD患者腹主动脉钙化的独立危险因素，而25羟维生素D3是MHD患者腹主动脉钙化的保护因素（P＜0.05）。结论：MHD患者腹主动脉钙化与LVMI、预后密切相关，且年龄、透析龄、以及血磷、全段甲状旁腺激素、25羟维生素D3、LVMI均是MHD患者腹主动脉钙化的影响因素。

The Relationship between Abdominal Aortic Calcification and Left Ventricular Mass Index, Prognosis and Analysis of Its Influencing Factors in Maintenance Hemodialysis Patients

ABSTRACT Objective: To study the relationship between abdominal aortic calcification, left ventricular mass index (LVMI), prognosis and its influencing factors in patients with maintenance hemodialysis (MHD). Methods: 182 MHD patients who were admitted to the hospital from May 2016 to June 2018 were included in the study. All patients were divided into calcification group (abdominal aortic calcification score>0) with n=145 cases and non calcification group (abdominal aorta calcification score=0) with n=37 cases according to abdominal aorta calcification score. The differences of LVMI, clinical baseline data and laboratory test indexes between the two groups were analyzed and compared. Multivariate logistic regression analysis was used to identify the influencing factors of abdominal aortic calcification in MHD patients. Results: LVMI in the calcification group was significantly higher than that in the non-calcification group, the difference was statistically significant(P<0.05). All-cause mortality and cardiovascular mortality in the calcification group were higher than those in the non-calcification group(P<0.05). Kaplan-meier survival analysis showed that the all-cause survival rate and cardiovascular survival rate in the calcification group were significantly lower than those in the non-calcification group(P<0.05). The age, dialysis age, levels of blood phosphorus and full-length parathyroid hormone in the calcification group were all higher than those in the non-calcification group, while the levels of 25 hydroxyvitamin D3 was lower than that in the non-calcification group(P<0.05). Multiple Logistic regression analysis showed that age, dialysis age, blood phosphorus, full-length parathyloid hormone and LVMI were independent risk factors for abdominal aortic calcification in MHD patients, while 25 hydroxyvitamin D3 was protective factor for abdominal aortic calcification in MHD patients(P<0.05). Conclusion: Abdominal aortic calcification in MHD patients is closely related to LVMI and prognosis, and the age, dialysis age, blood phosphorus, full-length parathyroid hormone, 25 hydroxyvitamin D3 and LVMI are all influencing factors of abdominal aortic calcification in MHD patients.