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目的观察慢性肾脏病(chronic kidney disease,CKD)5期糖尿病肾病和非糖尿病肾病患者心瓣膜钙化发生情况,探讨糖尿病肾病对心瓣膜钙化的影响。方法未行血液透析治疗的CKD 5期心瓣膜钙化患者104例,其中糖尿病肾病患者48例(DN组),非糖尿病肾病患者56例(NDN组),2组均行超声心动图检查,观察心瓣膜钙化发生部位及心瓣膜功能;采用多元线性逐步回归分析影响CKD患者心瓣膜钙化的危险因素。结果 104例患者超声心动图显示,心瓣膜钙化累及二尖瓣82例(78.84%),累及主动脉瓣80例(76.92%),累及三尖瓣26例(25.00%);DN组钙化心瓣膜反流率(100.00%)、狭窄并关闭不全发生率(8.33%)高于NDN组(85.71%,0)(P<0.05),心瓣膜钙化发生部位与NDN组比较差异无统计学意义(P>0.05);多元线性逐步回归分析结果显示,空腹血糖增高、高三酰甘油、高龄、低25-羟维生素D水平是CKD患者发生心瓣膜钙化的危险因素。结论伴糖尿病肾病的CKD 5期非透析患者心瓣膜功能失调发生率较高,糖尿病肾病是CKD患者心瓣膜钙化危险因素。
Objective To observe the occurrence of cardiac valve calcification in patients with stage 5 diabetic nephropathy and non-diabetic nephropathy with chronic kidney disease (CKD) and to investigate the effect of diabetic nephropathy on the valvular calcification. Methods 104 patients with CKD 5-stage heart valve calcification without hemodialysis were enrolled in this study. Among them, 48 patients with diabetic nephropathy (DN group) and 56 patients with non-diabetic nephropathy (NDN group), 2 patients underwent echocardiography, Valvular calcification site and heart valve function; using multiple linear stepwise regression analysis of risk factors for heart valve calcification in patients with CKD. Results Echocardiography of 104 patients showed that valvular calcification involved mitral valve in 82 patients (78.84%), aortic valve in 80 patients (76.92%) and tricuspid valve in 26 patients (25.00%). The calcified heart valve The rate of reflux (100.00%), stenosis and incomplete closure (8.33%) was higher than that of NDN (85.71%, 0) (P <0.05), and there was no significant difference between the valvular calcification site and NDN group > 0.05). Multivariate linear stepwise regression analysis showed that fasting blood glucose increased, triglyceride, age, and low 25-hydroxyvitamin D were risk factors for heart valve calcification in CKD patients. Conclusion The incidence of heart valve dysfunction in CKD stage 5 patients with diabetic nephropathy is high. Diabetic nephropathy is a risk factor of heart valve calcification in CKD patients.