Aortic calcification in haemodialysis patients with diabetes mellitus
Aortic calcification in haemodialysis patients with diabetes mellitus
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DOI：
10.1093/ndt/gfi039
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发表时间：
2005-11-01
影响因子：
6.1
通讯作者：
Nishizawa, Y
中科院分区：
文献类型：
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作者：
Taniwaki, H;Ishimura, E;Nishizawa, Y
背景资料。某些代谢紊乱，如高磷血症会导致血液透析患者的血管钙化；然而，目前尚不清楚这些代谢紊乱是否会导致糖尿病血液透析患者的主动脉钙化。本研究调查了大量血液透析患者主动脉钙化的危险因素，并比较了糖尿病患者和非糖尿病患者的危险因素。研究对象为667名维持性血液透析患者：184名2型糖尿病患者和483名非2型糖尿病患者。采用腹主动脉平扫CT图像半定量测量主动脉钙化程度，计算出主动脉钙化指数(ACI)。尽管糖尿病患者的透析时间明显短于非糖尿病患者(P<；0.0001)，但糖尿病患者的ACI显著高于非糖尿病患者(57.3vs44.8vs44.88.3%，P<；0.001)。多元回归分析显示糖尿病是ACI增加的显著独立危险因素。分别在糖尿病患者和非糖尿病患者中进行的多元回归分析显示，在两组患者中，高龄、较高的收缩压、吸烟和较长的血液透析年限是显著相关的共同的独立危险因素(非糖尿病患者的R2=0.296，P<；0.0001；糖尿病患者的R2=0.193，P<；0.0001)。在非糖尿病患者中，血磷浓度升高是一个显著的独立因素(β=0.150，P<；0.0005)，但在糖尿病患者中，血磷浓度升高与脑梗塞并无显著相关性(P=0.429)。与非糖尿病患者相比，糖尿病血液透析患者的主动脉钙化更严重，即使血液透析时间较短。由于矿物质代谢紊乱与糖尿病血液透析患者的主动脉钙化没有显著相关性，这些患者的主动脉钙化可能会受到与糖尿病状态本身相关的代谢异常的影响，而不受其他混杂因素的影响；以及主动脉钙化。甚至在血液透析诱导之前，阳离子就可能被推进。
Background. Certain metabolic disorders, such as hyperphosphatemia induce vascular calcification in haemodialysis patients; it is unclear, however, whether these disorders contribute to aortic calcification in diabetic haemodialysis patients. This study examined the risk factors of aortic calcification in a large number of haemodialysis patients, and compared risk factors between diabetic and non-diabetic patients.Methods. The subjects were 667 patients on maintenance haemodialysis: 184 with type 2 diabetes and 483 without. Aortic calcification was measured semiquantitatively using a plain computed tomography image of the abdominal aorta, and an aortic calcification index (ACI) was calculated.Results. The ACI of the diabetic subjects was significantly higher than that of those without diabetes (57.3 +/- 22.1 vs 44.8 +/- 28.3%, P < 0.0001), although the dialysis vintage of the former was significantly shorter (P < 0.001). Multiple regression analyses showed that diabetes was a signficant independent risk factor for increased ACI. Multiple regression analyses, performed separately in diabetics and non-diabetics, revealed that advanced age, higher systolic blood pressure, smoking and longer haemodialysis vintage were common independent risk factors significantly associated with increased ACI in both patient groups (R-2 = 0.296, P < 0.0001 for non-diabetics; R-2 = 0.193, P < 0.0001 for diabetics). Higher serum phosphate concentration was not significantly associated with increased ACI in diabetic patients (P = 0.429), although it was a significant independent factor in non-diabetic patients (beta = 0.150, P < 0.0005).Conclusion. Aortic calcification in diabetic haemodialysis patients is more advanced, compared with non-diabetic patients, even with short haemodialysis vintage. Since disorders of mineral metabolism are not significantly associated with aortic calcification in diabetic haemodialysis patients, aortic calcification in these patients could be affected by metabolic abnormalities associated with the diabetic state per se, independent of other confounding factors; and aortic calci. cation may be advanced even before haemodialysis induction.