维持性血液透析患者血尿酸和脂蛋白（a）与心脏瓣膜钙化的关系

摘要/Abstract

摘要： 目的：分析维持性血液透析（maintenance hemodialysis，MHD）患者血尿酸（serum uric acid，SUA）和脂蛋白（a）[lipoprotein(a)， Lp（a）]与心脏瓣膜钙化（cardiac valve calcification，CVC）的关系。方法：选取2017年1月至2018年12月在我院血液净化中心治疗的MHD患者80例作为研究对象。采用超声心动图检测MHD患者CVC的情况，按照主动脉瓣膜、二尖瓣瓣膜或瓣环是否出现1个或多个>1 mm的强回声分为CVC组（n=25）和无CVC组（n=55）。测定血常规、碱性磷酸酶、透前肾功能、透后肾功能、SUA、Lp（a）、钙、磷、C-反应蛋白、β2-微球蛋白、甲状旁腺素等指标。比较两组MHD患者上述指标的变化，分析SUA和Lp（a）与其相关性。结果：CVC组与无CVC组患者性别（χ2=2.690，P=0.101）、年龄（t=0.498，P=0.620）、透析龄（t=-0.103，P=0.917）、尿素下降率（t=-0.704，P=0.483）、残余尿量（t=-0.077，P=0.939）、是否有糖尿病病史（χ2=0.069，P=0.792）等比较，差异均无统计学意义。CVC组患者SUA（t=2.845，P=0.008）、碱性磷酸酶（t=2.026，P=0.046）、β2-微球蛋白（t=2.408，P=0.018）、血钙（t=2.048，P=0.044）、甲状旁腺素（t=2.083，P=0.041）、Lp（a）（t=2.005，P=0.048）水平高于无CVC组。相关性分析显示，MHD患者SUA与碱性磷酸酶（r=0.264，P=0.018）、β2-微球蛋白（r=0.294，P=0.008）、甲状旁腺素（r=0.373，P=0.001）、Lp（a）（r=0.260，P=0.020）呈正相关。多元线性逐步回归分析显示，SUA是心脏瓣膜钙化（β=-0.002，P=0.001）的独立危险因素。结论：MHD患者SUA和Lp（a）与CVC的发生、发展密切相关。

关键词: font-size:medium, ">维持性血液透析；血尿酸；脂蛋白（a）；心脏瓣膜钙化

Abstract: Objective： To investigate the association between serum uric acid (SUA) and lipoprotein(a) [Lp(a)]and cardiac valve calcification (CVC) in maintenance hemodialysis patients (MHD). Methods： Totally 80 MHD patients in Blood Purification Center of Qingdao Chengyang People′s Hospital were enrolled in our study. CVC was detected by the color doppler ultrasonography. The patients were allocated into CVC group (n=25) or non-CVC group (n=55) according to the presence or absence of aortic valve or mitral valve or annulus calcification. Complete blood count， alkaline phosphatase， renal function， SUA， Lp(a)， calcium， phosphorus， C-reactive protein， β2-microglobulin and parathyroid hormone were assayed. Changes of these parameters in different groups and their relevance to SUA and Lp(a) levels were analyzed. Results： No statistical significance was attained in gender(χ2=2.690， P=0.101)， age (t=0.498， P=0.620)， dialysis age(t=-0.103， P=0.917)， urea reduction rate(t=-0.704， P=0.483)， residual urine volume (t=-0.077， P=0.939) and the presence or absence of diabetes(χ2=0.069， P=0.792) between CVC group and non-CVC group. Compared to non-CVC group， the SUA(t=2.845， P=0.008)， alkaline phosphatase(t=2.026， P=0.046)， β2-microglobulin(t=2.408， P=0.018)， calcium(t=2.048， P=0.044)， intact parathyroid hormone(t=2.083， P=0.041) and Lp(a)( t=2.005， P=0.048) were significantly higher in CVC group. Correlation studies revealed that SUA levels were positively correlated with alkaline phosphatase(r=0.264，P=0.018)， β2-microglobulin(r=0.294， P=0.008)， intact parathyroid(r=0.373， P=0.001) and Lp(a) (r=0.260， P=0.020). Multivariate regression analysis results showed that SUA was an independently risk factor for CVC(β=-0.002， P=0.001). Conclusion： SUA and Lp(a) are closely related to the occurrence and development of CVC in MHD patients.

Key words: font-size:medium, ">Maintenance hemodialysis； Serum uric acid； Lipoprotein(a)； Cardiac valve calcification

中图分类号:

姚丹丹, 姜国珍, 仇方忻. 维持性血液透析患者血尿酸和脂蛋白（a）与心脏瓣膜钙化的关系[J]. 中国医药导刊, 2020, 22(4): 247-251.

YAO Dandan, JIANG Guozhen, QIU Fangxin. Association between Serum Uric Acid and Lipoprotein(a) and Cardiac Valve Calcification in Maintenance Hemodialysis Patients[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2020, 22(4): 247-251.

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