Shih Ming-Chen Paul, Lee Mei-Yueh, Huang Jiun-Chi, Tsai Yi-Chun, Chen Jui-Hsin, Chen Szu-Chia, Chang Jer-Ming, Chen Hung-Chun
From the Department of Medical Imaging (M-CPS); Division of Endocrinology and Metabolism (M-YL); Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital (J-CH, Y-CT, S-CC, J-MC, H-CC); Department of Internal Medicine (M-YL, J-CH, S-CC); Department of Nursing, Kaohsiung Municipal Hsiao-Kang Hospital (J-HC); Faculty of Medicine, College of Medicine (M-YL, Y-CT, S-CC, H-CC); and Department of Medical Imaging, Kaohsiung Medical University Hospital; Taiwan Department of Radiology, Faculty of Medicine (M-CPS), Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C.
Medicine (Baltimore). 2016 May;95(19):e3643. doi: 10.1097/MD.0000000000003643.
Aortic arch calcification (AoAC) is associated with cardiovascular and all-cause mortality in end-stage renal disease population. AoAC can be simply estimated with an AoAC score using plain chest radiography. The objective of this study is to evaluate the association of AoAC with brachial-ankle pulse wave velocity (baPWV) and cardiomegaly in patients who have undergoing hemodialysis (HD).We retrospectively determined AoAC and cardiothoracic ratio (CTR) by chest x-ray in 220 HD patients who underwent the measurement of baPWV. The values of baPWV were measured by an ankle-brachial index-form device. Multiple stepwise logistic regression analysis was used to identify the factors associated with AoAC score >4.Compared patients with AoAC score ≦4, patients with AoAC score >4 had older age, higher prevalence of diabetes and cerebrovascular disease, lower diastolic blood pressure, higher baPWV, higher CTR, higher prevalence of CTR ≧50%, lower total cholesterol, and lower creatinine level. After the multivariate stepwise logistic analysis, old age, cerebrovascular disease, high baPWV (per 100 cm/s, odds ratio [OR] 1.065, 95% confidence interval [CI] 1.003-1.129, P = 0.038), CTR (per 1%, OR 1.116, 95% CI 1.046-1.191, P = 0.001), and low total cholesterol level were independently associated with AoAC score >4.Our study demonstrated AoAC severity was associated with high baPWV and high CTR in patients with HD. Therefore, we suggest that evaluating AoAC on plain chest radiography may be a simple and inexpensive method for detecting arterial stiffness in HD patients.
主动脉弓钙化（AoAC）与终末期肾病患者的心血管疾病及全因死亡率相关。使用胸部平片的AoAC评分可简单估算AoAC。本研究的目的是评估接受血液透析（HD）的患者中AoAC与肱踝脉搏波速度（baPWV）及心脏扩大的相关性。我们回顾性地通过胸部X线确定了220例接受baPWV测量的HD患者的AoAC和心胸比率（CTR）。baPWV值通过踝臂指数形式的设备测量。采用多步逻辑回归分析来确定与AoAC评分>4相关的因素。与AoAC评分≤4的患者相比，AoAC评分>4的患者年龄更大、糖尿病和脑血管疾病患病率更高、舒张压更低、baPWV更高、CTR更高、CTR≥50%的患病率更高、总胆固醇更低以及肌酐水平更低。经过多变量逐步逻辑分析，老年、脑血管疾病、高baPWV（每100 cm/s，比值比[OR] 1.065，95%置信区间[CI] 1.003 - 1.129，P = 0.038）、CTR（每1%，OR 1.116，95% CI 1.046 - 1.191，P = 0.001）以及低总胆固醇水平与AoAC评分>4独立相关。我们的研究表明，HD患者的AoAC严重程度与高baPWV和高CTR相关。因此，我们建议通过胸部平片评估AoAC可能是检测HD患者动脉僵硬度的一种简单且廉价的方法。
