关键词:

心脏瓣膜钙化, 颈动脉粥样硬化, 腹膜透析, 全因死亡, 心血管死亡

Abstract:

Objective To analyze the association of cardiac valve calcification（CVC）and carotid athero⁃ sclerosis（CAS）on the prognosis in maintenance peritoneal dialysis patients，and to investigate the value of combin⁃ ing CVC and CAS on all⁃cause and cardiovascular mortality in PD patients. Methods Patients underwent regular PD duration of ≥ 3 months in PD center of Wuxi people′s hospital affiliated to Nanjing Medical University from July 2015 to December 2015 were enrolled in this study. Their clinical and laboratory information was gathered，cardiac echocardiography and carotid artery color Doppler ultrasound examination were performed in the patients. CVC and CAS are considered as risk markers，The patients were assigned to three groups based on their risk markers（0， 1，and 2）. All patients were followed up until death，PD discontinuation，or study termination（June 30，2020）. The Kaplan⁃Meier method was used to analyze all⁃cause and cardiovascular mortality. The Cox proportional hazard model was used to analyze the prediction of all⁃cause mortality and cardiovascular mortality by risk markers 0，1， and 2. Results A total of 166 patients with PD were enrolled，46（27.7%）patients were with CVC and 88（53.0%） patients were with CAS，70（42.2%）patients had no risk markers，58（34.9%）patients had 1 risk marker（CVC or CAS），and 38（22.9%）patients had 2 risk markers（CVC and CAS）. By the end of the study，34 patients had died， and 21 patients were due to cardiovascular events. According to the Kaplan⁃Meier，differences in all⁃cause and cardiovascular mortality between the three groups（P < 0.001）. The Cox regression analysis revealed that the HR for all⁃cause mortality in PD patients with 2 and 1 risk markers were 8.011（95%CI： 2.493 ~ 25.741，P = 0.001）and 2.711（95%CI：0.820 ~ 8.961，P = 0.102），and the HR for cardiovascular mortality was 6.734（95%CI：1.643 ~ 27.610，P = 0.008）and 1.694（95%CI：0.385 ~ 7.460，P = 0.486），compared with those without risk markers. When combined with both risk markers，the area under the curve（AUC）of all⁃cause and cardiovascular mortality increased when compared to any single risk marker. Conclusion CVC and CAS are risk markers for PD patients，and the combination of these two markers can better predict PD patient prognosis.

Key words:

cardiac valve calcification, carotid atherosclerosis, peritoneal dialysis, all?cause mor? tality, cardiovascular mortality