Wu Ching-Fang, Lee Yee-Fan, Lee Wen-Jeng, Su Chi-Ting, Lee Lukas Jyuhn-Hsiarn, Wu Kwan-Dun, Chen Pau-Chung, Kao Tze-Wah
Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
Department of Medical Imaging, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
J Formos Med Assoc. 2017 May;116(5):366-372. doi: 10.1016/j.jfma.2016.06.006. Epub 2016 Aug 3.
BACKGROUND/PURPOSE: Vascular calcification can predict cardiovascular (CV) morbidity and mortality in patients with end-stage renal disease. We evaluated the prevalence, association factors, and outcomes of chest X-ray-detected aortic arch calcification (AoAC) in patients undergoing peritoneal dialysis (PD).
We included 190 patients undergoing PD (mean age, 52.6 ± 14.3 years) for whom chest radiographs were available. AoAC revealed by chest X-ray was graded from 0 to 3 according to an AoAC score (AoACS). Multiple regression analyses were used to determine the factors associated with AoACS. After adjusting for age, sex, PD duration, diabetes mellitus, mean blood pressure, and history of CV disease, the association between AoAC grading and mortality were assessed using the Kaplan-Meier curve and Cox proportional hazard model.
Age (p < 0.001), PD duration (p = 0.004), history of CV disease (p < 0.001), and renal Kt/V (p = 0.031) were associated with AoACS. After a mean follow-up of 55.1 ± 32.1 months, patients with Grade 2 (p = 0.011) or Grade 3 (p < 0.001) AoAC had higher all-cause mortality than patients with Grade 0 AoAC. In addition, patients with Grades 2 and 3 AoAC had higher CV-related mortality than those with Grades 0 and 1 AoAC (p = 0.013). Grade 2 [hazard ratio (HR) = 2.736; 95% confidence interval (CI), 1.038-7.211; p = 0.042] and Grade 3 AoAC (HR = 3.289; 95% CI, 1.156-9.359; p = 0.026) remained associated with all-cause mortality after adjustment. Similarly, Grades 2 and 3 AoAC (HR = 36.05; 95% CI, 3.494-372; p = 0.026) significantly correlated with CV mortality after adjustment.
In patients undergoing PD, CXR-detected severe AoAC was an independent risk factor for all-cause and CV mortalities.
背景/目的：血管钙化可预测终末期肾病患者的心血管（CV）发病率和死亡率。我们评估了接受腹膜透析（PD）患者胸部X线检测到的主动脉弓钙化（AoAC）的患病率、相关因素及预后情况。
我们纳入了190例有胸部X线片的接受PD治疗的患者（平均年龄52.6±14.3岁）。根据主动脉弓钙化评分（AoACS）将胸部X线显示的AoAC从0到3级进行分级。采用多元回归分析确定与AoACS相关的因素。在调整年龄、性别、PD疗程、糖尿病、平均血压和CV疾病史后，使用Kaplan-Meier曲线和Cox比例风险模型评估AoAC分级与死亡率之间的关联。
年龄（p<0.001）、PD疗程（p=0.004）、CV疾病史（p<0.001）和肾脏Kt/V（p=0.031）与AoACS相关。平均随访55.1±32.1个月后，2级（p=0.011）或3级（p<0.001）AoAC患者的全因死亡率高于0级AoAC患者。此外，2级和3级AoAC患者的CV相关死亡率高于0级和1级AoAC患者（p=0.013）。调整后，2级[风险比（HR）=2.736；95%置信区间（CI），1.038-7.211；p=0.042]和3级AoAC（HR=3.289；95%CI，1.15-9.359；p=0.026）仍与全因死亡率相关。同样，调整后2级和3级AoAC（HR=36.05；95%CI，3.494-372；p=0.026）与CV死亡率显著相关。
在接受PD治疗的患者中，胸部X线检测到的严重AoAC是全因死亡率和CV死亡率的独立危险因素。
