关键词: 心脏瓣膜疾病, 慢性肾脏病, 心脏瓣膜钙化, 危险因素, 影响因素分析

Abstract: Background　Cardiac valve calcification（CVC）may maximally increase the risk of developing cardiovascular disease in patients with chronic kidney disease（CKD）.Increasing understanding of bone mineral metabolism and the use of new non-calcium phosphate binders and calcimimetic agents in CKD patients，requires a new analysis of clinical characteristics of this population.And there are few studies on CVC in CKD patients as a risk factor for cardiovascular disease.Objective　To explore the prevalence and risk factors of CVC in patients with CKD stages 3-5.Methods　Patients with CKD stages 3-5 with and without dialysis treated in Department of Nephrology，Zhongda Hospital，Southeast University from August 2014 to July 2019 were selected and their demographic，serological and imaging data were collected.According to the presence of CVC，they were divided into calcification group and non-calcification group.Logistic regression and subgroup analyses were used to explore the risk factors of CVC.Results　 Of the included 1 383 cases，619（44.8%）were identified with CVC，of whom 426（30.8%）with aortic valve calcification（AVC），37（2.7%）with mitral valve calcification（MVC），150（10.9%）with both AVC and MVC，and 6（0.4%）with other diseases.Compared to non-calcification group，calcification group had higher proportions of women，dialysis recipients，previous or present users of statins，and cases with elevated C-reactive protein（more than 3 mg/L），greater mean age，higher prevalence of concomitant diabetes，concomitant hypertension，concomitant coronary heart disease，concomitant cerebral infarction and left ventricular hypertrophy，and higher mean levels of serum calcium，albumin and alkaline phosphatase（P<0.05）.Calcification group also showed lower proportion of previous or present users of calcium carbonate，and lower mean levels of creatinine，triglyceride，total cholesterol and low-density lipoprotein（P<0.05）.In multivariate logistic regression analysis，older age 〔OR=1.065，95%CI（1.053，1.077）〕，dialysis 〔OR=1.917，95%CI（1.423，2.582）〕，concomitant coronary heart disease 〔OR=1.608，95%CI（1.134，2.281）〕，lower level of hemoglobin 〔OR=0.993，95%CI（0.987，0.999）〕，higher level of alkaline phosphatase 〔OR=1.002，95%CI（1.000，1.003）〕 and elevated C-reactive protein（more than 3 mg/L）〔OR=1.478，95%CI（1.095，1.995）〕 were significantly associated with the presence of CVC in patients with CKD（P<0.05）.Advanced age 〔OR=1.078，95%CI（1.057，1.099）〕 and history of statins use 〔OR=1.853，95%CI（1.003，3.424）〕 were risk factors of CVC in non-dialysis patients with 3-5 stages of CKD（P<0.05）.Advanced age 〔OR=1.081，95%CI（1.061，1.101）〕，long dialysis duration 〔OR=1.123，95%CI（1.067，1.181）〕，hypertension 〔OR=3.071，95%CI（1.453，6.490）〕 and history of calcium carbonate use〔OR=0.515，95%CI（0.300，0.882）〕 were risk factors for CVC in patients with CKD stage 5D and dialysis duration more than one year（P<0.05）.Conclusion　The prevalence of CVC in patients with CKD stages 3-5 was 44.8% in our study.And the prevalence of AVC was higher than that of MVC.Elevated alkaline phosphatase，lower level of hemoglobin，older age，dialysis，concomitant coronary heart disease and elevated C-reactive protein may be potential risk factors of CVC in these patients.

Key words: Heart valve diseases, Chronic kidney disease, Cardiac valve calcification, Risk factors, Root cause analysis