慢性肾脏病5期患者冠状动脉钙化的危险因素及受累血管特征分析

Risk factors and vascular characteristics associated with coronary artery calcification in patients with stage 5 chronic kidney disease

摘要

目的 探讨慢性肾脏病(CKD)5期患者冠状动脉钙化(CAC)的独立危险因素,评估血清钙(Ca²⁺)与糖化血红蛋白(HbA1c)对CAC发生及严重程度的预测价值,并分析冠状动脉分支钙化负荷的分布差异。方法 回顾性纳入263例CKD 5期住院患者,根据冠状动脉CT血管成像(CCTA)结果分为钙化组(n=103)和非钙化组(n=160)。收集患者临床资料、血清学资料及冠脉钙化积分(CACS),通过单因素及多因素Logistic回归分析CAC的危险因素,采用线性回归和多重比较评估Ca²⁺、HbA1c与CACS的相关性,并通过方差分析比较不同冠脉分支的钙化负荷差异。结果 多因素Logistic回归分析显示:年龄、糖尿病以及Ca²⁺、血清磷(P³⁺)、碱性磷酸酶升高是CAC的独立危险因素(P＜0.01)。在CKD 5期患者中,HbA1c≥5.8%(40 mmol/mol)组和Ca²⁺≥2.25 mmol/L组的CACS均显著高于对照组(P＜0.01),且HbA1c和Ca²⁺均与log(CACS+1)呈正相关(r=0.364和r=0.233,P＜0.001)。此外,冠状动脉左前降支(LAD)的钙化积分显著高于其他冠脉分支(P＜0.001)。结论 CKD 5期患者的CAC与高龄、糖尿病以及Ca²⁺、P³⁺、碱性磷酸酶升高密切相关;HbA1c和Ca²⁺对CAC严重程度具有一定的预测价值,LAD为CAC受累相对更严重的冠脉分支。

Abstract

Objective To identify independent risk factors for coronary artery calcification (CAC) in patients with stage 5 chronic kidney disease (CKD), to evaluate the predictive value of serum calcium (Ca²⁺) and glycated hemoglobin (HbA1c) for the occurrence and severity of CAC, and to analyze the differences in calcific load across various coronary arterial branches. Methods A total of 263 hospitalized patients with stage 5 CKD were retrospectively included and divided into calcified group (n=103) and non-calcified group (n=160) based on their coronary computed tomography angiography (CCTA) results. The patients' demographic and biochemistry data, as well as coronary artery calcification score (CACS), were collected. Risk factors for CAC were analyzed using univariate and multivariate Logistic regression. Linear regression and multiple comparisons were employed to evaluate the correlation of Ca²⁺ and HbA1c with CACS. Variance analysis were employed to compare the differences in calcium load of different coronary branches. Results Multivariate Logistic regression analysis revealed that age, diabetes mellitus, and elevated levels of Ca²⁺, serum phosphorus (P³⁺) and alkaline phosphatase (ALP) were independent risk factors for CAC (P＜0.01). In patients with stage 5 CKD, CACS was significantly elevated in the groups with HbA1c levels ≥5.8% (40 mmol/mol) and Ca²⁺ levels ≥2.25 mmol/L compared to the control group (P＜0.01). Furthermore, both HbA1c and Ca²⁺ levels were positively correlated with log(CACS+1) (r=0.364 and r=0.233, P＜0.001). Additionally, the calcium score of the left anterior descending coronary artery (LAD) was significantly higher than that of the other coronary branches (P＜0.001). Conclusion CAC in patients with stage 5 CKD is closely associated with advanced age, diabetes mellitus, and elevated levels of Ca²⁺, P³⁺ and ALP. HbA1c and Ca²⁺ serve as effective predictors of CAC severity. The LAD is the coronary artery branch that is relatively more severely affected by CAC.

关键词

慢性肾脏病(CKD) / 冠状动脉钙化(CAC) / 危险因素 / 糖化血红蛋白(HbA1c) / 血清钙

Key words

chronic kidney disease (CKD) / coronary artery calcification (CAC) / risk factor / glycated hemoglobin (HbA1c) / serum calcium

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基金资助

陕西省自然科学基础研究计划项目(2023-JC-YB-708)