血清钙磷乘积（Ca×PO4）作为透析前患者心血管疾病风险的预测指标

Product of serum calcium and phosphorus (Ca × PO4) as predictor of cardiovascular disease risk in predialysis patients.

作者信息

Regmi Prashant, Malla Bimala, Gyawali Prajwal, Sigdel Manoj, Shrestha Rojeet, Shah Dibya Singh, Khanal Madhav Prasad

机构信息

Department of Clinical Biochemistry, Nepal Medical College, Kathmandu, Nepal.

Charite- Universitä tsmedizin Berlin, Germany.

出版信息

Clin Biochem. 2014 Jan;47(1-2):77-81. doi: 10.1016/j.clinbiochem.2013.09.012. Epub 2013 Sep 22.

DOI:10.1016/j.clinbiochem.2013.09.012

PMID:24064489

Abstract

OBJECTIVES

The mortality rate of chronic kidney disease (CKD) patients is very high due to cardiovascular diseases (CVD) which cannot be fully justified by traditional CVD markers. Since, mineral bone disorder is common in CKD, product of serum calcium and phosphorus (Ca × PO4) can be a predictor of future CVD. So, our study aims to assess the utility of higher Ca × PO4 in prediction of CVD risk in predialysis CKD patients.

DESIGN AND METHODS

150 CKD patients defined by NKF-KDOQI guideline not undergoing dialysis were recruited. Anthropometric and electrocardiographic parameters were recorded. We evaluated CVD risk by: i) Biochemical CVD markers, ii) NCEP ATP III guideline postulated risk factors and iii) Framingham risk scores.

RESULTS

Higher Ca × PO4 is associated with presence of Left Ventricular Hypertrophy, oxidative stress, microinflammation, hyperhomocysteinemia, hypercholesterolemia, hypertriglyceridemia and increased LDLc. Compared to cases with Ca × PO4 <55 mg2/dL2, cases with ≥55 mg2/dL2 had relative risk (RR) of 1.82 (95% CI 1.25-2.64) for CVD, 3.24 (95% CI 2.37-4.41) for stroke and 2.43 (95% CI 1.37-4.31) for coronary heart disease (CHD). Moreover, compared to lowest quartile of Ca x PO4, the highest quartile group had RR of 2.13 (95% CI 1.06-4.28) for CVD, 2.61(95% CI 1.80-3.75) for stroke and 2.84 (95% CI 1.15-7.0) for CHD.

CONCLUSION

In predialysis patients, higher Ca × PO4 is independent predictor of CVD risk.

摘要

目的

慢性肾脏病（CKD）患者因心血管疾病（CVD）导致的死亡率非常高，而传统的CVD标志物无法完全解释这一现象。由于矿物质骨代谢紊乱在CKD中很常见，血清钙和磷的乘积（Ca×PO4）可能是未来CVD的一个预测指标。因此，我们的研究旨在评估较高的Ca×PO4在预测未透析CKD患者CVD风险中的作用。

设计与方法

招募了150名符合NKF-KDOQI指南定义的未接受透析的CKD患者。记录人体测量和心电图参数。我们通过以下方式评估CVD风险：i）生化CVD标志物，ii）NCEP ATP III指南假定的风险因素，以及iii）弗雷明汉风险评分。

结果

较高的Ca×PO4与左心室肥厚、氧化应激、微炎症、高同型半胱氨酸血症、高胆固醇血症、高甘油三酯血症以及LDLc升高有关。与Ca×PO4<55mg2/dL2的患者相比，Ca×PO4≥55mg2/dL2的患者发生CVD的相对风险（RR）为1.82（95%CI 1.25-2.64），中风的RR为3.24（95%CI 2.37-4.41），冠心病（CHD）的RR为2.43（95%CI 1.37-4.31）。此外，与Ca×PO4最低四分位数组相比，最高四分位数组发生CVD的RR为2.13（95%CI 1.06-4.28），中风的RR为2.61（95%CI 1.80-3.75），CHD的RR为2.84（95%CI 1.15-7.0）。