红细胞分布宽度对不同透析方式患者胸主动脉钙化的预测价值

doi:10.3969/j.issn.1004-583X.2024.02.009

摘要/Abstract

摘要：

目的分析维持性透析患者胸主动脉钙化(thoracic aortic calcification, TAC)的危险因素,探讨红细胞分布宽度(red cell distribution width, RDW)在血液透析和腹膜透析患者中对TAC的预测价值。方法共收集190例于2022年1月至2022年6月在昆明医科大学第二附属医院长期维持性透析患者的资料,根据胸部X线检查结果是否合并TAC分为钙化组(n=48)和非钙化组(n=142)进行组间比较,采用二元Logistic回归分析患者发生TAC的危险因素,并应用ROC曲线分析RDW对不同透析方式患者发生TAC的预测价值。结果本组TAC发生率为25.3%。钙化组RDW比非钙化组高(P<0.01),多因素二元Logistic回归分析显示RDW[OR=1.541, 95%CI(1.145, 2.074), P=0.004]、年龄[OR=1.041, 95%CI(1.008, 1.075), P=0.014]、透析龄[OR=1.016, 95%CI(1.002, 1.031), P=0.025]、血磷[OR=2.172, 95%CI(1.109, 4.253), P=0.024]是透析患者发生TAC的独立危险因素。RDW预测血液透析患者TAC发生的ROC曲线下面积(AUC=0.719)比腹膜透析患者曲线下面积(AUC=0.661)更大。结论 RDW是透析患者发生TAC的独立危险因素,RDW对血液透析患者发生TAC的预测价值比腹膜透析更好。

关键词: 红细胞指数, 透析, 主动脉, 胸, 预测价值

Abstract:

Objective To analyze the risk factors of thoracic aortic calcification (TAC) in maintenance dialysis patients, and to explore the predictive value of red cell distribution width (RDW) in TAC of patients with hemodialysis and peritoneal dialysis. Methods Clinical data of 190 patients on long-term maintenance dialysis in the Second Affiliated Hospital of Kunming Medical University from January 2022 to June 2022 were collected. According to the finding of TAC on chest X-ray scans, patients were divided into calcification group (n=48) and non-calcification group (n=142). Risk factors of TAC in dialysis patients were analyzed by binary logistic regression analysis. The receiver operating characteristic (ROC) curve was applied to analyze the predictive value of RDW in TAC of patients with different dialysis modalities. Results The proportion of TAC was 25.3%. The RDW was significantly higher in the calcification group than that of the non-calcification group (P<0.01). Multivariate Logistic regression analysis showed that RDW (OR=1.541, 95%CI: 1.145, 2.074, P=0.004), age (OR=1.041, 95%CI: 1.008, 1.075, P=0.014), duration of dialysis (OR=1.016, 95%CI: 1.002, 1.031, P=0.025) and serum phosphate (OR=2.172, 95%CI: 1.109, 4.253, P=0.024) were independent risk factors for TAC in dialysis patients. The area under the curve (AUC) of RDW in predicting TAC in hemodialysis patients was larger than that in peritoneal dialysis patients (0.719 vs 0.661). Conclusion RDW is an independent risk factor for TAC in dialysis patients, and it has a better predictive value in hemodialysis patients than that in peritoneal dialysis patients.

Key words: erythrocyte indices, dialysis, aorta, thoracic, predictive value

中图分类号:

R446.113

张凤, 蒋红樱, 杨娇, 李瑞和, 贺婷, 李萌. 红细胞分布宽度对不同透析方式患者胸主动脉钙化的预测价值[J]. 临床荟萃, 2024, 39(2): 144-148.

Zhang Feng, Jiang Hongying, Yang Jiao, Li Ruihe, He Ting, Li Meng. Predictive value of red cell distribution width in thoracic aorta calcification in patients with different dialysis modalities[J]. Clinical Focus, 2024, 39(2): 144-148.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.02.009

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I2/144

图/表 5

参考文献 26

[1]	Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease[J]. Am J Kidney Dis, 1998, 32(5 Suppl 3):S112-119. doi: 10.1053/ajkd.1998.v32.pm9820470 pmid: 9820470
[2]	Cho A, Jung HY, Park HC, et al. Relationship between abdominal aortic calcification on plain radiograph and coronary artery calcification detected by computed tomography in hemodialysis patients?[J]. Clin Nephrol, 2020, 93(3):123-129. doi: 10.5414/CN109988 URL
[3]	Liu ZH, Yu XQ, Yang JW, et al. Prevalence and risk factors for vascular calcification in Chinese patients receiving dialysis: Baseline results from a prospective cohort study[J]. Curr Med Res Opin, 2018, 34(8):1491-1500. doi: 10.1080/03007995.2018.1467886 URL
[4]	Zurauskaite G, Meier M, Voegeli A, et al. Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study[J]. PLoS One, 2018, 13(1):e0191280. doi: 10.1371/journal.pone.0191280 URL
[5]	魏宇涵, 赵亚楠, 张桂彬, 等. 单核细胞/高密度脂蛋白胆固醇比值、红细胞分布宽度、尿酸与冠心病患者冠状动脉病变严重程度的相关性[J]. 临床荟萃, 2023, 38(9):796-801.
[6]	李洛华, 李静, 蒋红樱, 等. 红细胞分布宽度与维持性透析患者生存率的相关性研究[J]. 临床肾脏病杂志, 2019, 19(9):639-646.
[7]	Hashimoto H, Iijima K, Hashimoto M, et al. Validity and usefulness of aortic arch calcification in chest X-ray[J]. J Atheroscler Thromb, 2009, 16(3):256-264. doi: 10.5551/jat.e570 pmid: 19556724
[8]	Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: A cross-sectional survey[J]. Lancet, 2012, 379(9818):815-822. doi: 10.1016/S0140-6736(12)60033-6 pmid: 22386035
[9]	Tatami Y, Yasuda Y, Suzuki S, et al. Impact of abdominal aortic calcification on long-term cardiovascular outcomes in patients with chronic kidney disease[J]. Atherosclerosis, 2015, 243(2):349-355. doi: 10.1016/j.atherosclerosis.2015.10.016 pmid: 26519631
[10]	Abdelmalek JA, Stark P, Walther CP, et al. Associations between coronary calcification on chest radiographs and mortality in hemodialysis patients[J]. Am J Kidney Dis, 2012, 60(6):990-997. doi: 10.1053/j.ajkd.2012.06.018 pmid: 22883135
[11]	段朝阳, 姚智会, 刘晓唤, 等. 血清sclerostin水平与维持性血液透析患者血管钙化的关系[J]. 西安交通大学学报(医学版), 2018, 39(3):349-352.
[12]	宋玉环, 郎佳慧, 李苹苹, 等. 维持性血液透析患者腹主动脉钙化特点及影响因素分析[J]. 临床肾脏病杂志, 2020, 20(12):951-954.
[13]	周晓玲, 郭一丹, 张春霞, 等. 维持性血液透析患者主动脉弓钙化的相关风险因素及其对远期预后的影响[J]. 中华肾脏病杂志, 2021, 37(3):191-197. doi: 10.3760/cma.j.cn441217-20200511-00030
[14]	王喆, 魏芳, 毕学青, 等. 维持性血液透析患者腹主动脉钙化进展的危险因素分析[J]. 中华肾脏病杂志, 2018, 34(5):327-333. doi: 10.3760/cma.j.issn.1001-7097.2018.05.002
[15]	周佳雯. 衰老机制及其干预研究进展[J]. 医学研究生学报, 2021, 34(5):524-529.
[16]	孙学娇, 刘乃丰. 关注糖尿病与血管钙化的共同发病机制和临床意义[J]. 中国动脉硬化杂志, 2020, 28(2):169-174.
[17]	谢俊, 郭子宏. 高血糖致动脉粥样硬化的机制研究及进展[J]. 中国老年保健医学, 2018, 16(3):124-127.
[18]	魏兰霁, 陈仲. 高糖环境促进小鼠血管钙化对细胞核心蛋白聚糖的表达研究[J]. 中国处方药, 2019, 17(5):7-9.
[19]	杨洁, 陈天怡, 王玲. 维持性血液透析患者腹主动脉钙化的危险因素[J]. 中国老年学杂志, 2021, 41(16):3467-3471.
[20]	郑佩兰, 林曰勇, 庄永泽, 等. 维持性血液透析患者腹主动脉钙化进展的危险因素分析[J]. 中国中西医结合肾病杂志, 2022, 23(11):968-971.
[21]	Poz D, De Falco E, Pisano C, et al. Diagnostic and prognostic relevance of red blood cell distribution width for vascular aging and cardiovascular diseases[J]. Rejuvenation Res, 2019, 22(2):146-162. doi: 10.1089/rej.2018.2094 pmid: 30132390
[22]	王增帅, 王孺贤, 高丽芝, 等. 红细胞体积分布宽度与颈动脉粥样硬化的关系[J]. 中国老年学杂志, 2019, 39(11):2610-2612.
[23]	Gürel OM, Demircelik MB, Bilgic MA, et al. Association between red blood cell distribution width and coronary artery calcification in patients undergoing 64-multidetector computed tomography[J]. Korean Circ J, 2015, 45(5):372-377. doi: 10.4070/kcj.2015.45.5.372 pmid: 26413104
[24]	Zhang T, Li J, Lin Y, et al. Association between red blood cell distribution width and all-cause mortality in chronic kidney disease patients: A systematic review and meta-analysis[J]. Arch Med Res, 2017, 48(4):378-385. doi: S0188-4409(17)30152-2 pmid: 28916240
[25]	李天慧, 赵班, 陈爱群, 等. 红细胞分布宽度动态变化可预测腹膜透析患者死亡[J]. 中国血液净化, 2020, 19(8):537-542.
[26]	曾颖, 欧阳涵, 姜山, 等. 红细胞分布宽度预测维持性血液透析患者预后的价值[J]. 中华肾脏病杂志, 2019, 35(4):259-267. doi: 10.3760/cma.j.issn.1001-7097.2019.04.004

项目	总体(n=190)	非钙化组(n=142)	钙化组(n=48)	t/χ²/Z值	P值
性别[例(%)]
男女	118(62.1) 72(37.9)	84(59.2) 58(40.8)	34(70.8) 14(29.2)	2.079	0.149
透析方式[例(%)]	190(100)	142(74.7)	48(25.3)	0.169	0.681
血液透析	106(55.8)	78(54.9)	28(58.3)
腹膜透析	84(44.2)	64(45.1)	20(41.7)
年龄(岁)	56.8±13.9	55.1±14.2	62.0±11.9	-3.023	0.003
透析龄(月)	46.1±26.7	44.1±24.7	52.0±31.3	-1.780	0.077
体重(kg)	60.17±11.99	59.413±12.154	62.417±11.297	-1.506	0.134
身高(cm)	164.0(157,169)	163(156,168)	165(158,170)	-1.308	0.191
原发病[例(%)]	190(100)	142(74.7)	48(25.3)	5.512	0.598
原发性肾小球疾病	47(24.7)	37(26.1)	10(20.8)
糖尿病肾病	61(32.1)	41(28.9)	20(41.7)
高血压肾病	42(22.1)	33(23.2)	9(18.8)
其他原因肾病	40(21.1)	31(21.8)	9(18.8)
合并糖尿病[例(%)]	61(32.1)	41(67.2)	20(32.8)	2.694	0.101
合并高血压[例(%)]	161(84.7)	124(77.0)	37(23.0)	2.909	0.088
合并冠心病[例(%)]	30(15.8)	20(66.7)	10(33.3)	1.229	0.268
合并脑血管病[例(%)]	17(8.9)	12(70.6)	5(29.4)	0.014	0.904
红细胞计数(×10¹²/L)	3.52±0.74	3.49±0.75	3.59±0.73	-0.767	0.444
血红蛋白(g/L)	104.51±21.90	104.40±22.48	104.71±20.37	-0.074	0.941
红细胞平均体积(fl)	91.35(86.48,95.73)	91.35(86.48,95.73)	90.35(86.08,95.80)	-0.874	0.382
红细胞血红蛋白平均含量(pg)	29.95(28.30,31.43)	30.15(28.60,31.50)	29.45(27.20,31.28)	-1.909	0.056
红细胞血红蛋白平均浓度(g/L)	327.00(319.00,334.00)	328.50(319.75,336.00)	323.50(318.25,329.75)	-2.490	0.013
RDW(%)	14.11(13.51,15.18)	13.95(13.40,14.78)	14.75(14.00,16.30)	-4.007	0.000
白蛋白(g/L)	38.00(30.15, 41.60)	37.75(29.23,42.30)	38.35(30.43,40.10)	-0.442	0.659
前白蛋白(mg/L)	300.79±87.81	309.18±89.02	276.25±81.15	0.704	0.025
血尿素(mmol/L)	19.79±7.09	19.45±6.76	20.75±8.10	-0.998	0.322
血肌酐(μmol/L)	946.33±313.40	948.13±324.54	939.04±287.27	0.186	0.853
血尿酸(mmol/L)	409.00(358.00,486.70)	408.00(357.30, 479.00)	407.00(357.00,491.80)	-0.252	0.801
总胆固醇(mmol/L)	4.04(3.37,4.85)	4.04(3.29,4.86)	4.02(3.42,4.75)	-0.203	0.839
甘油三酯(mmol/L)	1.57(1.07,2.45)	1.57(1.04,2.33)	1.55(1.06,2.92)	-0.984	0.325
高密度脂蛋白胆固醇(mmol/L)	0.96(0.79,1.18)	0.99(0.81,1.19)	0.85(0.73,1.17)	-1.465	0.143
低密度脂蛋白胆固醇(mmol/L)	2.44(1.91,2.99)	2.49(1.86,3.04)	2.24(1.97,2.82)	-0.320	0.749
血糖(mmol/L)	4.96(4.34,6.16)	4.88(4.26,5.87)	5.65(4.58,7.06)	-2.505	0.012
血钙(mmol/L)	2.22(2.01,2.33)	2.23(2.01,2.35)	2.17(2.00,2.33)	-0.761	0.447
血磷(mmol/L)	1.68(1.358,2.03)	1.68(1.29,2.01)	1.91(1.35,2.73)	-1.296	0.195
甲状旁腺激素(pg/ml)	323.34(173.46,715.21)	298.85(162.82,696.22)	372.53(210.13,807.68)	-1.303	0.193

项目	总体(n=190)	非钙化组(n=142)	钙化组(n=48)	t/χ²/Z值	P值
性别[例(%)]
男女	118(62.1) 72(37.9)	84(59.2) 58(40.8)	34(70.8) 14(29.2)	2.079	0.149
透析方式[例(%)]	190(100)	142(74.7)	48(25.3)	0.169	0.681
血液透析	106(55.8)	78(54.9)	28(58.3)
腹膜透析	84(44.2)	64(45.1)	20(41.7)
年龄(岁)	56.8±13.9	55.1±14.2	62.0±11.9	-3.023	0.003
透析龄(月)	46.1±26.7	44.1±24.7	52.0±31.3	-1.780	0.077
体重(kg)	60.17±11.99	59.413±12.154	62.417±11.297	-1.506	0.134
身高(cm)	164.0(157,169)	163(156,168)	165(158,170)	-1.308	0.191
原发病[例(%)]	190(100)	142(74.7)	48(25.3)	5.512	0.598
原发性肾小球疾病	47(24.7)	37(26.1)	10(20.8)
糖尿病肾病	61(32.1)	41(28.9)	20(41.7)
高血压肾病	42(22.1)	33(23.2)	9(18.8)
其他原因肾病	40(21.1)	31(21.8)	9(18.8)
合并糖尿病[例(%)]	61(32.1)	41(67.2)	20(32.8)	2.694	0.101
合并高血压[例(%)]	161(84.7)	124(77.0)	37(23.0)	2.909	0.088
合并冠心病[例(%)]	30(15.8)	20(66.7)	10(33.3)	1.229	0.268
合并脑血管病[例(%)]	17(8.9)	12(70.6)	5(29.4)	0.014	0.904
红细胞计数(×10¹²/L)	3.52±0.74	3.49±0.75	3.59±0.73	-0.767	0.444
血红蛋白(g/L)	104.51±21.90	104.40±22.48	104.71±20.37	-0.074	0.941
红细胞平均体积(fl)	91.35(86.48,95.73)	91.35(86.48,95.73)	90.35(86.08,95.80)	-0.874	0.382
红细胞血红蛋白平均含量(pg)	29.95(28.30,31.43)	30.15(28.60,31.50)	29.45(27.20,31.28)	-1.909	0.056
红细胞血红蛋白平均浓度(g/L)	327.00(319.00,334.00)	328.50(319.75,336.00)	323.50(318.25,329.75)	-2.490	0.013
RDW(%)	14.11(13.51,15.18)	13.95(13.40,14.78)	14.75(14.00,16.30)	-4.007	0.000
白蛋白(g/L)	38.00(30.15, 41.60)	37.75(29.23,42.30)	38.35(30.43,40.10)	-0.442	0.659
前白蛋白(mg/L)	300.79±87.81	309.18±89.02	276.25±81.15	0.704	0.025
血尿素(mmol/L)	19.79±7.09	19.45±6.76	20.75±8.10	-0.998	0.322
血肌酐(μmol/L)	946.33±313.40	948.13±324.54	939.04±287.27	0.186	0.853
血尿酸(mmol/L)	409.00(358.00,486.70)	408.00(357.30, 479.00)	407.00(357.00,491.80)	-0.252	0.801
总胆固醇(mmol/L)	4.04(3.37,4.85)	4.04(3.29,4.86)	4.02(3.42,4.75)	-0.203	0.839
甘油三酯(mmol/L)	1.57(1.07,2.45)	1.57(1.04,2.33)	1.55(1.06,2.92)	-0.984	0.325
高密度脂蛋白胆固醇(mmol/L)	0.96(0.79,1.18)	0.99(0.81,1.19)	0.85(0.73,1.17)	-1.465	0.143
低密度脂蛋白胆固醇(mmol/L)	2.44(1.91,2.99)	2.49(1.86,3.04)	2.24(1.97,2.82)	-0.320	0.749
血糖(mmol/L)	4.96(4.34,6.16)	4.88(4.26,5.87)	5.65(4.58,7.06)	-2.505	0.012
血钙(mmol/L)	2.22(2.01,2.33)	2.23(2.01,2.35)	2.17(2.00,2.33)	-0.761	0.447
血磷(mmol/L)	1.68(1.358,2.03)	1.68(1.29,2.01)	1.91(1.35,2.73)	-1.296	0.195
甲状旁腺激素(pg/ml)	323.34(173.46,715.21)	298.85(162.82,696.22)	372.53(210.13,807.68)	-1.303	0.193

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
年龄	0.038	0.013	8.398	0.004	1.039	1.012	1.066
透析龄	0.011	0.006	3.055	0.080	1.011	0.999	1.023
身高	0.031	0.023	1.710	0.188	1.032	0.985	1.080
体重	0.021	0.014	2.218	0.136	1.021	0.994	1.049
合并糖尿病	0.565	0.346	2.661	0.103	1.760	0.892	3.470
合并高血压	-0.717	0.426	2.831	0.092	0.488	0.212	1.126
合并冠心病	0.473	0.430	1.214	0.271	1.605	0.692	3.725
合并脑血管病	0.231	0.561	0.170	0.680	1.260	0.420	3.780
RDW	0.513	0.131	15.360	<0.01	1.670	1.292	2.158
前白蛋白	-0.004	0.002	4.913	0.027	0.996	0.992	0.999
总胆固醇	0.017	0.144	0.013	0.908	1.017	0.767	1.347
甘油三酯	0.189	0.101	3.462	0.063	1.208	0.990	1.474
低密度脂蛋白胆固醇	-0.047	0.193	0.059	0.807	0.954	0.654	1.392
血糖	0.140	0.057	5.957	0.015	1.150	1.028	1.286
血钙	-0.818	0.655	1.559	0.212	0.441	0.122	1.593
血磷	0.497	0.270	3.391	0.066	1.645	0.969	2.793
甲状旁腺激素	0.000	0.000	0.066	0.797	1.000	1.000	11.001

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
年龄	0.038	0.013	8.398	0.004	1.039	1.012	1.066
透析龄	0.011	0.006	3.055	0.080	1.011	0.999	1.023
身高	0.031	0.023	1.710	0.188	1.032	0.985	1.080
体重	0.021	0.014	2.218	0.136	1.021	0.994	1.049
合并糖尿病	0.565	0.346	2.661	0.103	1.760	0.892	3.470
合并高血压	-0.717	0.426	2.831	0.092	0.488	0.212	1.126
合并冠心病	0.473	0.430	1.214	0.271	1.605	0.692	3.725
合并脑血管病	0.231	0.561	0.170	0.680	1.260	0.420	3.780
RDW	0.513	0.131	15.360	<0.01	1.670	1.292	2.158
前白蛋白	-0.004	0.002	4.913	0.027	0.996	0.992	0.999
总胆固醇	0.017	0.144	0.013	0.908	1.017	0.767	1.347
甘油三酯	0.189	0.101	3.462	0.063	1.208	0.990	1.474
低密度脂蛋白胆固醇	-0.047	0.193	0.059	0.807	0.954	0.654	1.392
血糖	0.140	0.057	5.957	0.015	1.150	1.028	1.286
血钙	-0.818	0.655	1.559	0.212	0.441	0.122	1.593
血磷	0.497	0.270	3.391	0.066	1.645	0.969	2.793
甲状旁腺激素	0.000	0.000	0.066	0.797	1.000	1.000	11.001

	AUC	标准误	P值	95%CI		灵敏度	特异度	约登指数	界值
	AUC	标准误	P值	下限	上限	灵敏度	特异度	约登指数	界值
血液透析	0.719	0.055	<0.01	0.610	0.827	0.750	0.590	0.34	14.2%
腹膜透析	0.661	0.068	0.018	0.528	0.795	0.650	0.660	0.31	14.4%