Department of Nephrology, Peking University People's Hospital, Beijing, China.
Nephrology (Carlton). 2020 Jul;25(7):551-558. doi: 10.1111/nep.13632. Epub 2019 Aug 29.
Several studies have verified that unfractionated heparin (UFH) and low molecular heparin (LWMH) can induce bone loss, and bone mineral density has been inversely associated with vascular calcification in some clinical researches. But few have focused on the relationship between types and dosages of heparin and the progression of vascular calcification. We observed the progression of coronary artery calcification (CAC) in maintenance haemodialysis (MHD) patients who were treated with UFH and LMWH.
This was a prospective prevalent cohort study of MHD patients. Computed tomography was performed at enrolment and 2 years after enrolment, and CAC score was obtained. Demographic and clinical data, baseline and time-average laboratory indices were collected. Multiple linear regression and logistic regression were used to estimate the influencing factors of progression of CAC.
In this study, (i) we initially enrolled 69 HD patients, and then 56 patients finished the follow-up. (ii) Among the total 56 patients, 27 patients (48.2%) were treated with UFH, 14 (25.0%) with LMWH and 15 (26.8%) with both. The median baseline CAC scores of three groups (UFH, LMWH and both users) were 91.0 (1.0, 1052.0), 134.0 (0, 1292.0) and 250.5 (27.0, 1139.0), respectively, with no significant difference (P = 0.663); the median CAC progression scores were 42.0 (0, 364.0), 172.0 (7.0, 653.0) and 118.5 (0, 434.0), respectively, with no significant difference (P = 0.660). (iii) Pearson and spearman correlation analysis shown that the progression of CAC was not associated with cumulative dosage of heparin used. (iv) After adjusted for diabetes mellitus, time-averaged intact parathyroid hormone, phosphate and alkaline phosphatase, logistic regression analysis showed using different types of heparin was not an independent risk factor for CAC progression; and multiple linear regression analysis showed that the type of heparin used was not associated with CAC progression.
There were no significant differences in the effects of the types and dosages of heparin on CAC progression in patients on haemodialysis.
多项研究已经证实，普通肝素（UFH）和低分子肝素（LMWH）可导致骨质流失，且在一些临床研究中，骨密度与血管钙化呈负相关。但是，很少有研究关注肝素的类型和剂量与血管钙化进展之间的关系。我们观察了使用 UFH 和 LMWH 治疗的维持性血液透析（MHD）患者的冠状动脉钙化（CAC）进展情况。
这是一项前瞻性的 MHD 患者队列研究。在入组时和入组后 2 年进行计算机断层扫描（CT），并获得 CAC 评分。收集人口统计学和临床数据、基线和时间平均实验室指标。采用多元线性回归和逻辑回归来估计 CAC 进展的影响因素。
在这项研究中，（i）我们最初招募了 69 名血液透析患者，然后有 56 名患者完成了随访。（ii）在这 56 名患者中，27 名（48.2%）患者使用 UFH，14 名（25.0%）患者使用 LMWH，15 名（26.8%）患者同时使用 UFH 和 LMWH。三组（UFH、LMWH 和两者使用者）的基线 CAC 评分中位数分别为 91.0（1.0，1052.0）、134.0（0，1292.0）和 250.5（27.0，1139.0），无显著差异（P=0.663）；CAC 进展评分中位数分别为 42.0（0，364.0）、172.0（7.0，653.0）和 118.5（0，434.0），无显著差异（P=0.660）。（iii）Pearson 和 spearman 相关分析显示，CAC 的进展与使用的肝素累积剂量无关。（iv）在校正糖尿病、时间平均完整甲状旁腺激素、磷酸盐和碱性磷酸酶后，逻辑回归分析显示，使用不同类型的肝素不是 CAC 进展的独立危险因素；多元线性回归分析显示，肝素的类型与 CAC 进展无关。
在血液透析患者中，肝素的类型和剂量对 CAC 进展的影响无显著差异。
