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

摘要： 背景　心脏瓣膜钙化（CVC）是慢性肾脏病（CKD）患者发生心血管疾病最高危险因素。伴随人们对CKD骨矿物质代谢认识深入和新型非钙磷结合剂、拟钙剂等使用，有必要重新分析此类人群临床特征，且国内外关于CKD患者CVC危险因素的研究较少。目的　探讨CKD患者CVC的发生率，并分析CKD患者发生CVC的危险因素。方法　选取东南大学附属中大医院肾内科2014年8月—2019年7月收治的CKD 3~5期透析和非透析患者为研究对象，采集其人口学资料、血清学指标及影像学资料。根据是否发生CVC分为钙化组与无钙化组，采用Logistic回归分析探讨CKD患者CVC的危险因素，并进行亚组分析。结果　本研究共纳入1 383例CKD 3~5期患者，其中CVC患者619例（44.8%）；单纯主动脉瓣膜钙化（AVC）426例（30.8%）、单纯左房室瓣瓣膜钙化（MVC）37例（2.7%）、AVC+MVC 150例（10.9%），其他6例（0.4%）。钙化组女性占比、年龄、透析占比、合并症（糖尿病、高血压、冠心病、脑梗死）占比、他汀类药物使用史、左心室肥厚占比、血清钙水平、血清蛋白水平、碱性磷酸酶水平、C反应蛋白（CRP）>3 mg/L占比均高于无钙化组，碳酸钙使用史占比、肌酐水平、三酰甘油水平、总胆固醇水平、低密度脂蛋白水平均低于无钙化组（P<0.05）。多因素Logistic回归分析结果显示，高龄〔OR=1.065，95%CI（1.053，1.077）〕、透析〔OR=1.917，95%CI（1.423，2.582）〕、合并冠心病〔OR=1.608，95%CI（1.134，2.281）〕、低血红蛋白〔OR=0.993，95%CI（0.987，0.999）〕、高碱性磷酸酶〔OR=1.002，95%CI（1.000，1.003）〕、CRP>3 mg/L占比高〔OR=1.478，95%CI（1.095，1.995）〕是CKD患者CVC的危险因素（P<0.05）；高龄〔OR=1.078，95%CI（1.057，1.099）〕、他汀类药物使用史〔OR=1.853，95%CI（1.003，3.424）〕是CKD 3~5期未透析患者CVC的危险因素（P<0.05）；高龄〔OR=1.081，95%CI（1.061，1.101）〕、透析时间长〔OR=1.123，95%CI（1.067，1.181）〕、合并高血压〔OR=3.071，95%CI（1.453，6.490）〕、碳酸钙使用史〔OR=0.515，95%CI（0.300，0.882）〕是CKD 5D期且透析时间>1年患者CVC的危险因素（P<0.05）。结论　本研究中心CKD 3~5期患者CVC发生率为44.8%，AVC较MVC发生率高。高碱性磷酸酶、低血红蛋白、高龄、透析、合并冠心病和CRP升高是CKD 3~5期患者CVC的潜在危险因素。

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