Medical Research Unit in Nephrology Diseases, CMNS XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico, D.F., Mexico.
Arch Med Res. 2013 Nov;44(8):638-44. doi: 10.1016/j.arcmed.2013.10.015. Epub 2013 Nov 8.
Cardiac valve calcification (VC) is a frequent complication in chronic kidney disease and is considered a risk factor for all-cause and cardiovascular mortality. However, little is known about the pathophysiology mechanisms that originate it and the factors associated with its development. We undertook this study to analyze the frequency and factors related to de novo development of mitral valve calcification (MVC) and aortic valve calcifications (AVC) in incident peritoneal dialysis (PD) patients.
A prospective cohort of 124 incident PD patients was studied. Demographic and clinical data were recorded and blood assayed at baseline and after 1 year of follow-up for calcium, phosphorus, glucose, urea, creatinine, cholesterol, triglycerides by spectrophotometry assay; high-sensitivity C-reactive protein (CRP) by immunoturbidimetric ultrasensitive assay, intact parathormone (iPTH) and osteocalcin by electrochemiluminescence, fetuin-A and osteoprotegerin by EDI-ELISA. Valve calcification was evaluated by M-mode bidimensional echocardiogram.
Sixty eight percent of patients were male, ages 43 ± 13 years; 51% were diabetic with 1.4 ± 1 months on PD. After 12.3 ± 1 months, 57 patients (46%) developed VC: AVC in 33 (57.8%), MVC in 15 (26.3%) and 9 (15.8%) patients in both valves. There was no correlation between AVC and MCV. In univariate logistic regression analysis, age, diabetes and elevated concentrations of OPG, iPTH and CRP were risk factors for development MVC. In multivariate analysis, only iPTH remained an independent risk factor as was also the case in AVC.
Age, diabetes, osteoprotegerin, parathormone and C-reactive protein are risk factors related to de novo development of MVC and iPTH for AVC in incident dialysis patients.
心脏瓣膜钙化（VC）是慢性肾脏病的常见并发症，被认为是全因和心血管死亡率的危险因素。然而，对于引发它的病理生理学机制以及与它的发展相关的因素知之甚少。我们进行这项研究是为了分析新发生腹膜透析（PD）患者二尖瓣钙化（MVC）和主动脉瓣钙化（AVC）的发生频率和相关因素。
研究了一个前瞻性队列的 124 名新发生的 PD 患者。记录人口统计学和临床数据，并在基线和 1 年随访时采集血液样本，用于分光光度法检测钙、磷、葡萄糖、尿素、肌酐、胆固醇、甘油三酯；免疫比浊法检测高敏 C 反应蛋白（CRP）；电化学发光法检测全段甲状旁腺激素（iPTH）和骨钙素； EDI-ELISA 法检测胎球蛋白 A 和护骨素。通过 M 型二维超声心动图评估瓣膜钙化。
68%的患者为男性，年龄 43 ± 13 岁；51%为糖尿病患者，PD 时间为 1.4 ± 1 个月。12.3 ± 1 个月后，57 名患者（46%）发生 VC：33 名患者（57.8%）出现 AVC，15 名患者（26.3%）出现 MVC，9 名患者（15.8%）同时出现两个瓣膜的 VC。AVC 与 MVC 之间无相关性。在单因素 logistic 回归分析中，年龄、糖尿病以及 OPG、iPTH 和 CRP 浓度升高是 MVC 发生的危险因素。在多因素分析中，只有 iPTH 仍然是一个独立的危险因素，在 AVC 中也是如此。
年龄、糖尿病、护骨素、甲状旁腺激素和 C 反应蛋白是新发生透析患者 MVC 发生的危险因素，iPTH 也是 AVC 的危险因素。
