摘要
目的分析慢性肾脏病(CKD)5期患者冠状动脉钙化及其危险因素。方法回顾性收集2020年1月~2021年12月于重庆大学附属涪陵医院接受住院治疗的307例CKD 5期患者的临床资料。采用多因素logistic回归模型分析CKD 5期患者冠状动脉钙化的危险因素,并建立CKD 5期患者冠状动脉钙化的列线图预测模型,采用受试者工作特征(ROC)曲线及Hosmer-Lemeshow检验方法对建立的列线图模型进行验证及评估。结果单因素分析结果显示,两组患者的性别、总胆固醇(TC)、甘油三酯(TG)、血红蛋白(Hb)、白蛋白(Alb)、甲状旁腺激素(PTH)、高血压情况比较,差异均无统计学意义(P>0.05);两组患者的年龄、透析情况、糖尿病情况、吸烟情况、Ca^(2+)、P^(3+)、碱性磷酸酶(ALP)、Mg^(2+)比较,差异均有统计学意义(P<0.05)。多因素分析结果显示,年龄、透析、糖尿病、吸烟、Ca^(2+)、P^(3+)、ALP均是CKD 5期患者冠状动脉钙化的危险因素(P<0.05),Mg^(2+)是CKD 5期患者冠状动脉钙化的保护因素(P<0.05)。依据上述8个风险因素建立CKD 5期患者冠状动脉钙化的列线图预测模型,ROC验证该模型的AUC为0.869(95%CI=0.829~0.908),提示该模型具有良好的区分度。Hosmer and Lemeshow检验方法验证该模型校准度良好,模型的预测价值与实际观测值的偏差比较,差异无统计学意义(χ^(2)=6.18,P=0.627)。结论年龄、透析情况、糖尿病情况、吸烟情况、Ca^(2+)、P^(3+)、ALP、Mg^(2+)均是导致CKD 5期患者冠状动脉钙化的危险因素,临床需针对以上因素进行干预,以降低患者冠状动脉钙化的风险。根据危险因素构建的列线图模型能有效预测CKD 5期患者冠状动脉钙化的发生。
Objective To examine the coronary artery calcification and identify its risk factors among patients with stage 5 chronic kidney disease(CKD)undergoing maintenance hemodialysis.Methods The clinical data of 307 patients with stage 5 chronic kidney disease(CKD)who were hospitalized in the department were retrospectively analyzed from January 2020 to December 2021,including the basic data of patients,whether they were complicated with hypertension,diabetes mellitus,smoking and dialysis,laboratory examination indexes and chest CT to evaluate whether there was coronary artery calcification.Initial univariate analysis was conducted on all independent variables,and those found to be significant were subsequently incorporated into a multivariate logistic regression model to assess the risk factors associated with coronary artery calcification in stage 5 CKD patients.Then we established a nomogram prediction model of coronary artery calcification in patients with stage 5 CKD.Receiver operating characteristic curve(ROC)and Hosmer and Lemeshow test were used to verify and evaluate the established nomogram model.Results There were statistical differences in age,dialysis,diabetes mellitus,smoking,serum calcium,serum phosphorus,alkaline phosphatase,serum magnesium between patients with calcification and patients without calcification(χ^(2)∕t=34.532,18.091,17.976,5.709,19.326,P<0.05).Age,dialysis,diabetes mellitus,smoking,serum calcium,serum phosphorus and alkaline phosphatase were risk factors for coronary artery calcification(P<0.05),and serum magnesium was a protective factor(P<0.05).A nomogram prediction model for coronary artery calcification in patients with stage 5 CKD was established according to the above eight risk factors,and the AUC value of the model was 0.869(95%CI=0.829~0.908)verified by ROC,suggesting that the model had good discrimination.Hosmer and Lemeshow test demonstrated that the deviation between the predicted value and the actual observed value was not statistically significant(χ^(2)=6.18,P=0.627),suggesting that the model was well calibrated.Conclusion Age,dialysis,diabetes mellitus,smoking,serum calcium,serum phosphorus,alkaline phosphatase and other factors are all risk factors for coronary calcification in patients with stage 5 CKD.It is necessary to carry out clinical intervention according to the above factors to reduce the risk of coronary calcification in patients.The nomogram model established in this study can effectively predict the occurrence of coronary calcification in patients with stage 5 CKD,provide help for clinical diagnosis and treatment,and improve the prognosis of patients with stage 5 CKD.
作者
张小翠
张皓文
左洪炜
牟爱华
毛界
庞玉洪
Zhang Xiaocui;Zhang Haowen;Zuo Hongwei(Department of Nephrology,Chongqing University Fuling Hospital,Chongqing 408000,China)
出处
《中华保健医学杂志》
2025年第1期77-80,共4页
Chinese Journal of Health Care and Medicine
基金
重庆市涪陵区科卫联合医学科研项目(2022KWLH012)。
关键词
维持性血液透析
冠状动脉钙化
危险因素
列线图
Maintenance hemodialysis
Coronary artery calcification
Risk factor
Nomogram
