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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2015, Vol. 12 ›› Issue (10) : 792 -797. doi: 10.3877/cma.j.issn.1672-6448.2015.10.011

所属专题： 文献；

心血管超声影像学

心脏瓣膜钙化对血液透析患者冠状动脉钙化积分的预测价值
李明霞1, 杨斌1, 李娟1, 戴云1, 王晓春1, 孙晖1, 王泓1,†()   
  1. 1. 210002　南京大学医学院附属金陵医院超声诊断科
  • 收稿日期:2014-11-14 出版日期:2015-10-01
  • 通信作者: 王泓

Cardiac valve calcification by echocardiography predicts coronary artery calcium scores in dialysis patients

Mingxia Li1, Bin Yang1, Juan Li1, Yun Dai1, Xiaochun Wang1, Hui Sun1, Hong Wang1,†()   

  1. 1. Department of Ultrasound, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
  • Received:2014-11-14 Published:2015-10-01
  • Corresponding author: Hong Wang
  • About author:
    Corresponding author: Wang Hong, Email:
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引用本文：

李明霞, 杨斌, 李娟, 戴云, 王晓春, 孙晖, 王泓. 心脏瓣膜钙化对血液透析患者冠状动脉钙化积分的预测价值[J]. 中华医学超声杂志（电子版）, 2015, 12(10): 792-797.

Mingxia Li, Bin Yang, Juan Li, Yun Dai, Xiaochun Wang, Hui Sun, Hong Wang. Cardiac valve calcification by echocardiography predicts coronary artery calcium scores in dialysis patients[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2015, 12(10): 792-797.

目的

利用超声心动图研究终末期肾病血液透析患者心脏瓣膜钙化情况，探讨瓣膜钙化对冠状动脉钙化的预测价值。

方法

对169例慢性肾病V期血液透析患者进行超声心动图检查评价心脏瓣膜钙化情况，并用多层螺旋CT扫描计算冠状动脉钙化积分。按照冠状动脉钙化积分11~100、101~400和≥400将患者分为3个危险等级；并根据心脏瓣膜钙化情况，将所有患者分为：无瓣膜钙化组、主动脉瓣钙化组、二尖瓣钙化组以及主动脉瓣、二尖瓣同时钙化组。Logistic回归分析瓣膜钙化与冠状动脉钙化积分危险分级之间的比值比。

结果

受检的169例血液透析患者中88例（52.07%）患者存在瓣膜钙化。当患者出现主动脉瓣钙化时，冠状动脉钙化积分≥400的比值比为4.61，95%可信区间为1.22~17.4（P=0.02），出现二尖瓣钙化时，冠脉钙化积分≥400的比值比为5.31，95%的可信区间为1.37~20.5（P=0.01），当出现主动脉瓣、二尖瓣同时钙化时，冠状动脉钙化积分≥400的比值比为16.94，95%可信区间为5.16~55.58（P=0.001）。

结论

血液透析患者心脏瓣膜钙化与冠状动脉钙化之间存在显著的相关性，超声心动图评价瓣膜钙化可以预测透析患者冠状动脉钙化的出现及危险分级。

关键词: 肾透析, 心脏瓣膜, 超声心动描记术，压力
Objective

To determine whether cardiac valve calcification on echocardiography could predict coronary artery calcium scores (CACS) in hemodialysis patients.

Methods

This was a cross-sectional study of 169 stage V hemodialysis patients. The presence of calcification of the cardiac valves was assessed by echocardiography. All patients underwent multi-slice spiral computed tomography for quantification of CACS. According to CACS, they were divided into 3 groups (11-100, 101-400, and≥400). According to cardiac valve calcification, they were divided into 4 groups: no valve calcification, aortic valve calcification, mitral valve calcification and aotic/mitral valve calcification. Logistic regression was used to calculate the odds ratios (ORs) of having a CACS greater than 10, 100 and 400 in presence of valve calcification.

Results

Eighty-eight patients (52.07%) had echocardiographic evidence of valvular calcification. Patients with aortic valve calcification, mitral valve calcification and aotic/mitral valve calcification had a significantly greater likelihood of having CACS≥400 [OR=4.61, 95% confidence interval (95%CI) 1.22-17.4, P=0.02; OR = 5.31, 95%CI 1.37-20.5, P=0.01; OR = 16.94, 95%CI 5.16-55.58, P=0.001].

Conclusions

The cardiac valve calcification in hemodialysis patients was strongly associated with the presence and degree of CACS independently of clinical risk factors. Echocardiography is a useful method to predict CACS in hemodialysis patients by detecting cardiac valve calcification.

Key words: Renal dialysis, Heart valves, Echocardiography, stress
表1 瓣膜钙化组与无瓣膜钙化组之间指标比较
组别 例数 透析时间（年） 血清钙（mmol/L） 血磷（mmol/L） iPTH（ng/L） BMI（kg/m2） 尿素氮（mmol/L）
无瓣膜钙化组 81 5.6±4.7 2.4±0.2 1.6±0.5 522±550 21.7±3.0 70.5±16.3
瓣膜钙化组 88 7.3±6.4 2.4±0.2 1.6±0.5 388±463 23.1±3.9 67.3±16.8
t值 ? -1.791 -1.177 0.244 -0.550 -0.342 -0.429
P值 ? 0.05 0.98 0.73 0.01 0.006 0.21
组别 例数 肌酐（mmol/L） 血糖（mmol/L） 总胆固醇（mmol/L） LDL（mmol/L） HDL（mmol/L） 三酰甘油（mmol/L）
无瓣膜钙化组 81 9.8±3.1 5.3±2.8 4.8±0.9 2.4±0.7 0.9±0.3 1.8±1.4
瓣膜钙化组 88 10.5±3.4 5.2±1.2 4.7±1.0 2.4±0.7 0.9±0.4 1.6±0.9
t值 ? 0.913 0.826 0.242 -0.059 -0.410 0.980
P值 ? 0.18 0.67 0.37 0.54 0.81 0.41
图2 患者女性，49岁，终末期肾病患者大动脉根部短轴观，主动脉瓣无冠瓣瓣尖钙化
表2 瓣膜钙化的相关危险因素
相关危险因素 标准回归系数 95%可信区间 P值
年龄 0.05 1.00~1.11 0.007
总胆固醇 5.39 1.32~22.1 0.019
三酰甘油 0.23 0.07~0.67 0.008
LDL 0.18 0.04~0.80 0.024
BMI 1.31 1.07~1.60 0.008
性别 0.08 0.17~0.42 0.003
表3 冠脉钙化的危险因素
相关危险因素 β系数 95%可信区间 P值
瓣膜钙化 1.02 0.46~1.57 0.001
年龄 0.05 0.001~0.10 0.049
iPTH 1.36 0.01~2.73 0.043
表4 瓣膜钙化与不同冠状动脉钙化积分的优势比
钙化部位 CACS（11~100） CACS（101~400） CACS（≥400）
OR值 P值 OR值 P值 OR值 P值
二尖瓣钙化 1.52（0.35~6.51） 0.57 3.49（1.04~11.7） 0.04 5.31（1.37~20.5） 0.01
主动脉瓣钙化 3.43（1.09~10.7） 0.03 2.29（0.67~7.80） 0.18 4.61（1.22~17.4） 0.02
2组瓣膜同时钙化 3.18（0.94~10.6） 0.06 1.52（0.35~6.56） 0.57 16.94（5.16~55.58） 0.001
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