目的:血管钙化在慢性肾脏病中常见且进展性,包括肾移植受者(KTRs)。然而,KTRs中与主动脉钙化(AoC)进展相关的危险因素尚未完全阐明.在本研究中,我们评估了AoC,并检查了与其在KTRs中进展相关的因素。
方法:这是一项前瞻性纵向研究,包括98个KTR。我们使用Agatston评分定量调查肾下腹部AoC,通过多层计算机断层扫描测量。基线调查后,3年后进行随访扫描,并再次获得Agatston评分。在校正了几个混杂因素后,使用非线性回归通过多变量分析检查了影响第二Agatston评分的实验室数据的变化。
结果:第二Agatston评分明显高于基线Agatston评分(p<0.001)。在对混杂因素进行调整后,校正后血清钙的变化与Agatston第2次评分呈显著的非线性相关性(非线性方面p=0.022/校正后血清钙的影响方面p=0.031).此外,校正血清钙对AoC进展的影响与基线AoC存在相互作用,在基线Agatston评分较高的患者中,高钙血症的影响更大(p=0.049).
结论:本研究显示高钙血症是KTRs肾下腹部AoC发生的危险因素。此外,在血管钙化更严重的患者中,高钙血症的影响更大.
OBJECTIVE: Vascular calcification is common and progressive in chronic kidney disease, including kidney transplant recipients (KTRs). However, the risk factors associated with the progression of aortic calcification (AoC) in KTRs have not been fully elucidated. In the present study, we evaluated AoC and examined the factors associated with its advancement in KTRs.
METHODS: This was a prospective longitudinal study that included 98 KTRs. We quantitatively investigated infrarenal abdominal AoC using the Agatston score, as measured by multi-slice computed tomography. After the baseline investigation, a follow-up scan was performed after 3 years, and the Agatston scores were obtained again. The changes in laboratory data affecting the 2nd Agatston scores were examined by multivariable analysis using non-linear regression after adjustment for several confounders.
RESULTS: The 2nd Agatston scores were significantly greater than the baseline Agatston scores (p < 0.001). After adjustment for the confounders, the change in corrected serum calcium exhibited a significant non-linear correlation with the 2nd Agatston scores (p = 0.022 for non-linearity/p = 0.031 for the effect of corrected serum calcium). Moreover, an interaction was present from the baseline AoC in the effect of corrected serum calcium on the progression of AoC, and the effect of hypercalcemia was greater in patients with higher baseline Agatston scores (p = 0.049).
CONCLUSIONS: The present study revealed that hypercalcemia is a risk factor for the development of infrarenal abdominal AoC in KTRs. Furthermore, the effect of hypercalcemia was greater in patients with more severe vascular calcification.