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目的探讨心脏瓣膜钙化(HVC)对维持性血液透析(MHD)患者心血管预后的影响。方法入组2009~2011年302例MHD患者(其中99例伴HVC),所有患者随访2年,采用生存曲线分析心血管终点事件,Cox回归分析心脏瓣膜钙化对心血管预后的影响。结果患者初始透析的平均年龄为58.2岁,男性占53.6%。随访2年,HVC与非HVC组患者全因死亡、心血管死亡和新发心血管事件发生率分别为30.3%vs 16.3%、22.2%vs 6.9%和48.5%vs 25.6%(P<0.05)。生存曲线分析显示两组在全因死亡率(Log Rank P=0.006)、心血管死亡(P<0.001)和新发心血管事件(P<0.001)方面均存在统计学差异。Cox回归分析显示,校正后HVC仍然显著增加患者全因死亡[HR 1,88,95%CI:(1.11-3.19)]、心血管死亡[3.47(1.76-6.84)]和新发心血事件风险[1.64(1.09-2.47)]。结论 HVC是MHD患者心血管死亡及新发心血管事件的独立危险因素。
Objective To investigate the effect of heart valve calcification (HVC) on cardiovascular outcomes in maintenance hemodialysis (MHD) patients. Methods A total of 302 MHD patients (99 with HVC) were enrolled from 2009 to 2011. All patients were followed up for 2 years. Cardiovascular end points were analyzed by survival curves. Cox regression analysis was performed to evaluate the effect of heart valve calcification on cardiovascular outcomes. Results The average age of initial dialysis patients was 58.2 years, 53.6% of men. All patients were followed up for 2 years. The incidence of all-cause death, cardiovascular death and new cardiovascular events in HVC and non-HVC patients were 30.3% vs 16.3%, 22.2% vs 6.9% and 48.5% vs 25.6%, respectively (P <0.05). Survival curves showed statistically significant differences in all-cause mortality (Log Rank P = 0.006), cardiovascular death (P <0.001), and new cardiovascular events (P <0.001). Cox regression analysis showed that after the correction, HVC still significantly increased all-cause death [HR 1,88,95% CI: (1.11-3.19)], cardiovascular death [3.47 (1.76-6.84)] and risk of new-onset cardiovascular events [ 1.64 (1.09-2.47)]. Conclusions HVC is an independent risk factor for cardiovascular death and new cardiovascular events in patients with MHD.