Adragao Teresa, Pires Ana, Lucas Carlos, Birne Rita, Magalhaes Luís, Gonçalves Margarida, Negrao Acácio Pita
Nefroclinica-Estoril, Rua Vale de S Rita, 19, 2765-293 Esteril, Portugal.
Nephrol Dial Transplant. 2004 Jun;19(6):1480-8. doi: 10.1093/ndt/gfh217. Epub 2004 Mar 19.
Cardiovascular morbidity and mortality are highly prevalent in haemodialysis (HD) patients and have been recently associated with vascular calcifications. The objective of our study was to assess the value of a simple vascular calcification score for the prediction of cardiovascular death, cardiovascular hospitalizations and fatal and non-fatal cardiovascular events in HD patients, and to correlate this score with cardiovascular disease and with other known predictors of vascular disease.
In this observational, prospective study 123 chronic HD patients (75 males and 48 females; 20% diabetic) were included, who were on low-flux HD treatment for 46.6+/-52 months (mean+/-SD). We set up a simple vascular calcification score based on plain radiographic films of pelvis and hands. Brachial pulse pressure and mean arterial pressure (MAP) were measured and cardiovascular events and hospitalization episodes were assessed.
During an observational period of 37 months there were 17 cardiovascular deaths; 28 patients needed cardiovascular hospitalizations and 32 patients suffered fatal and non-fatal cardiovascular events. Coronary artery disease was diagnosed in 43 patients (35%), peripheral arterial disease in 33 patients (26.8%), cerebrovascular disease in 16 patients (13%) and vascular disease (coronary artery disease or peripheral arterial disease or cerebral vascular disease) in 61 patients (49.6%). By binary logistic regression, diabetes (P = 0.01), male sex (P<0.001), age (P = 0.02), HD duration (P = 0.02) and MAP (P = 0.03) were independently associated with a vascular score > or =3. This score > or =3 was independently associated with coronary artery disease (P = 0.008), peripheral arterial disease (P<0.001) and vascular disease (P = 0.001). Patients with a vascular calcification score > or =3 had a 3.9-fold higher risk of cardiovascular mortality (P = 0.03), a 2.8-fold higher risk of cardiovascular hospitalizations (P = 0.02) and a 2.3-fold higher risk of fatal or non-fatal cardiovascular events (P = 0.04).
The present vascular calcification scoring represents a simple tool for the assessment of cardiovascular risk related with vascular calcifications in chronic HD patients.
心血管疾病的发病率和死亡率在血液透析（HD）患者中非常普遍，并且最近与血管钙化有关。我们研究的目的是评估一种简单的血管钙化评分对于预测HD患者心血管死亡、心血管住院以及致命和非致命心血管事件的价值，并将该评分与心血管疾病以及其他已知的血管疾病预测因素相关联。
在这项观察性前瞻性研究中，纳入了123例慢性HD患者（75例男性和48例女性；20%为糖尿病患者），他们接受低通量HD治疗46.6±52个月（平均值±标准差）。我们基于骨盆和手部的X线平片建立了一个简单的血管钙化评分。测量肱动脉脉压和平均动脉压（MAP），并评估心血管事件和住院情况。
在37个月的观察期内，有17例心血管死亡；28例患者需要心血管住院治疗，32例患者发生了致命和非致命心血管事件。43例患者（35%）被诊断为冠状动脉疾病，33例患者（26.8%）为外周动脉疾病，16例患者（13%）为脑血管疾病，61例患者（49.6%）为血管疾病（冠状动脉疾病或外周动脉疾病或脑血管疾病）。通过二元逻辑回归分析，糖尿病（P = 0.01）、男性（P<0.001）、年龄（P = 0.02）、HD持续时间（P = 0.02）和MAP（P = 0.03）与血管评分≥3独立相关。该评分≥3与冠状动脉疾病（P = 0.008）、外周动脉疾病（P<0.001）和血管疾病（P = 0.00）独立相关。血管钙化评分≥3的患者心血管死亡风险高3.9倍（P = 0.03），心血管住院风险高2.8倍（P = 0.02），致命或非致命心血管事件风险高2.3倍（P = 0.04）。
目前的血管钙化评分是评估慢性HD患者中与血管钙化相关的心血管风险的一种简单工具。
