Background The coronary artery calcium （CAC） and aortic arch calcification （AoAC） are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined ...Background The coronary artery calcium （CAC） and aortic arch calcification （AoAC） are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina. Methods A total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3. Results During the four years of fol- low-up, 620 patients were treated by coronary stenting and 153 （7%） adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score 〈 400, AoAC showed an additive predictive value in detecting significant coronary artery disease （CAD）. A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score. Conclusions As AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays.展开更多
Background There was a causal relationship between elevated lipoprotein(a)[Lp(a)]levels and increased risk of calcific aortic valve stenosis(CAVS)in whites and blacks.The present study aimed to investigate whether Lp(...Background There was a causal relationship between elevated lipoprotein(a)[Lp(a)]levels and increased risk of calcific aortic valve stenosis(CAVS)in whites and blacks.The present study aimed to investigate whether Lp(a)levels were associated with aortic stenosis(AS)severity and clinical events in Chinese patients.Methods Levels of serum Lp(a)were measured in 652 patients with CAVS,whom all underwent baseline echocardiographic examination.The clinical endpoint was defined as a composite of aortic valve replacement(AVR)and cardiac death.Results Patients in the tertile 3 of Lp(a)had a higher percentage of severe AS compared with those in the tertile 1 and 2 of Lp(a)(46.2%vs.33.9%,P=0.005).Moreover,the top tertile of Lp(a)was an independent predictor of severe AS(OR=1.78,95%CI:1.18-2.66,P=0.006).However,there was no significant association between tertile 3 of Lp(a)and clinical events(hazard ratio:0.73;95%CI:0.43-1.24;P=0.239)in the multivariate Cox regression analysis during a mean follow-up time of 3.16±2.74 years.Conclusions Elevated Lp(a)level was an independent predictor of severe AS by echocardiography in the Chinese population,but was not associated with the increased risk of AVR and cardiac death,suggesting that Lp(a)levels might be helpful in the risk stratification of patients with CAVS.展开更多
目的研究维持性血液透析(maintenance hemodialysis,MHD)患者血浆致动脉硬化指数(atherogenic index of plasma,AIP)、淋巴细胞与单核细胞比值(lymphocyte/monocyte ratio,LMR)与腹主动脉钙化(abdominal aortic calcification,AAC)的相...目的研究维持性血液透析(maintenance hemodialysis,MHD)患者血浆致动脉硬化指数(atherogenic index of plasma,AIP)、淋巴细胞与单核细胞比值(lymphocyte/monocyte ratio,LMR)与腹主动脉钙化(abdominal aortic calcification,AAC)的相关性,并构建风险预测模型。方法选取2023年5月1日─2024年4月30日在首都医科大学附属北京潞河医院郎府院区血液净化中心接受MHD治疗的患者。通过单因素及多因素Logistic回归分析来确定ACC的危险因素,建立列线图,并进行内部验证。结果共纳入158例MHD患者,分为AAC组(n=106)和非AAC组(n=52);AAC组的年龄(F=1.325,P<0.001)、校正钙(F=0.343,P=0.016)、AIP(F=8.726,P=0.003)、合并糖尿病(F=9.287,P=0.002)高于非AAC组;透析时长(F=3.681,P=0.007)、血白蛋白(F=3.287,P=0.002)、血磷(F=0.344,P=0.018)、LMR(F=1.824,P=0.022)低于非AAC组。多因素Logistic回归分析发现高龄(OR=1.071,95%CI:1.034~1.108,P<0.001)、合并糖尿病(OR=3.346,95%CI:1.428~7.843,P=0.005)、高AIP(OR=1.176,95%CI:1.041~1.33,P=0.009)、低LMR(OR=0.777,95%CI:0.614~0.983,P=0.036)是MHD患者发生AAC的独立危险因素。绘制列线图,计算C-index为0.834(95%CI:0.769~0.899),说明该列线图模型的区分能力较好。绘制校准曲线,模拟曲线和实际曲线绝对误差为0.029,说明模型具有较强的一致性。结论对于MHD患者来说,高龄、合并糖尿病、高AIP、低LMR是MHD患者发生AAC的独立危险因素。依据年龄、糖尿病、AIP、LMR构建的风险预测模型有很好的预测效能。展开更多
目的探讨超敏C反应蛋白与白蛋白比值(hypersensitive C reactive protein to albumin ratio,CAR)与维持性血液透析(maintenance hemodialysis,MHD)患者腹主动脉钙化及全因死亡的相关性。方法选择2023年1月─2024年2月在首都医科大学附...目的探讨超敏C反应蛋白与白蛋白比值(hypersensitive C reactive protein to albumin ratio,CAR)与维持性血液透析(maintenance hemodialysis,MHD)患者腹主动脉钙化及全因死亡的相关性。方法选择2023年1月─2024年2月在首都医科大学附属北京潞河医院血液净化中心进行治疗的MHD患者为研究对象。收集符合纳入标准的患者的基本信息、规律透析治疗3个月后的生化指标、腹主动脉钙化及全因死亡情况。分析CAR与腹主动脉钙化的相关性,采用受试者工作曲线(ROC)分析CAR对腹主动脉钙化的诊断价值,采用Logistic回归分析CAR与全因死亡的关系。结果共纳入204例患者,其中腹主动脉钙化患者155例(75.98%),死亡患者11例(5.39%)。腹主动脉钙化组患者CAR高于非钙化组(Z=3.105,P=0.002)。Spearman相关性分析显示CAR与腹主动脉钙化呈正相关(r=0.218,P=0.002)。CAR诊断腹主动脉钙化的cutoff值为0.02 mg/g,敏感性为92.9%,特异性为36.7%,曲线下面积为0.647(95%CI:0.554~0.741,P=0.002)。Logistic回归分析显示年龄、透析龄、HbAlc是腹主动脉钙化的独立危险因素(OR=1.074、1.015、1.881,95%CI:1.040~1.110、1.007~1.024、1.188~2.978,P<0.001、<0.001、0.001),CAR是全因死亡的独立危险因素(OR=5.393,95%CI:1.089~26.699,P=0.039)。结论CAR与腹主动脉钙化呈正相关,CAR有助于腹主动脉钙化的诊断,且CAR是全因死亡的独立危险因素。展开更多
目的:探究慢性肾衰竭(Chronic renal failure,CRF)血液透析患者血小板分布宽度(Platelet distribution width,PDW)、白蛋白(Albumin,ALB)水平对腹主动脉钙化发生的影响。方法:纳入2020年1月至2021年10月我院130例CRF行血液透析患者,于...目的:探究慢性肾衰竭(Chronic renal failure,CRF)血液透析患者血小板分布宽度(Platelet distribution width,PDW)、白蛋白(Albumin,ALB)水平对腹主动脉钙化发生的影响。方法:纳入2020年1月至2021年10月我院130例CRF行血液透析患者,于透析治疗前检查患者PDW、血清ALB水平。透析治疗后开展12 m随访,记录所有患者透析治疗后腹主动脉钙化发生情况。分析PDW、血清ALB水平对血液透析患者并发腹主动脉钙化的影响。结果:共完成127例随访工作,其中发生腹主动脉钙化41例,占比32.28%。发生组治疗前PDW水平高于未发生组,血清ALB水平低于未发生组(P<0.05)。发生组高血压、肥胖例数占比高于未发生组(P<0.05)。经Logistic回归分析结果显示,治疗前高水平PDW、高血压、肥胖是CRF行血液透析患者发生腹主动脉钙化的危险因素(OR>1,P<0.05),治疗前高水平血清ALB是其保护因素(OR<1,P<0.05)。绘制受试者工作特征曲线,结果显示,PDW、血清ALB及联合预测CRF行血液透析患者发生腹主动脉钙化的曲线下面积均≥0.07,其中联合预测价值最高。结论:PDW水平高、血清ALB水平低是CRF行血液透析患者发生腹主动脉钙化的影响因素,联合检测二者水平可预测评估患者腹主动脉钙化发生风险。展开更多
目的系统性分析我国维持性血液透析(maintenance hemodialysis,MHD)患者并发腹主动脉钙化(abdominal aorta calcification,AAC)的危险因素。方法通过计算机对PubMed、Embase、Web of Science、中国知网、中国生物医学文献数据库CBM、万...目的系统性分析我国维持性血液透析(maintenance hemodialysis,MHD)患者并发腹主动脉钙化(abdominal aorta calcification,AAC)的危险因素。方法通过计算机对PubMed、Embase、Web of Science、中国知网、中国生物医学文献数据库CBM、万方等数据库检索关于中国MHD患者并发AAC危险因素的文献(时限为建库至2023年5月),采用纽卡斯尔-渥太华量表(Newcastle-Ottawa scale,NOS)、美国卫生保健质量和研究机构评价标准(agency for healthcare research and quality,AHRQ)进行方法学文献质量评价。采用RevMan 5.3软件进行Meta分析。结果共纳入15篇文献,其中10篇中文文献,5篇英文文献,包含2848例研究对象。Meta分析结果显示高龄(OR=1.080,95%CI:1.050~1.110,P<0.001)、长透析龄(OR=1.020,95%CI:1.010~1.040,P=0.008)、吸烟(OR=1.900,95%CI:1.440~2.500,P<0.001)、高体质量指数(body mass index,BMI)(OR=1.200,95%CI:1.050~1.110,P=0.001)、血钙升高(OR=14.140,95%CI:7.340~27.260,P<0.001)、血磷升高(OR=6.010,95%CI:2.040~17.750,P=0.001)、甲状旁腺激素升高(OR=1.310,95%CI:1.010~1.700,P=0.040)以及血镁(OR=0.490,95%CI:0.400~0.590,P<0.001)、25羟基维生素D3降低(OR=0.760,95%CI:0.610~0.950,P=0.020)为MHD患者并发AAC的危险因素。结论维持性血液透析患者并发腹主动脉钙化的影响因素较多,应重点关注高危人群,进行针对性、个性化干预,延缓MHD患者腹主动脉钙化的进展。展开更多
文摘Background The coronary artery calcium （CAC） and aortic arch calcification （AoAC） are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina. Methods A total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3. Results During the four years of fol- low-up, 620 patients were treated by coronary stenting and 153 （7%） adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score 〈 400, AoAC showed an additive predictive value in detecting significant coronary artery disease （CAD）. A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score. Conclusions As AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays.
文摘Background There was a causal relationship between elevated lipoprotein(a)[Lp(a)]levels and increased risk of calcific aortic valve stenosis(CAVS)in whites and blacks.The present study aimed to investigate whether Lp(a)levels were associated with aortic stenosis(AS)severity and clinical events in Chinese patients.Methods Levels of serum Lp(a)were measured in 652 patients with CAVS,whom all underwent baseline echocardiographic examination.The clinical endpoint was defined as a composite of aortic valve replacement(AVR)and cardiac death.Results Patients in the tertile 3 of Lp(a)had a higher percentage of severe AS compared with those in the tertile 1 and 2 of Lp(a)(46.2%vs.33.9%,P=0.005).Moreover,the top tertile of Lp(a)was an independent predictor of severe AS(OR=1.78,95%CI:1.18-2.66,P=0.006).However,there was no significant association between tertile 3 of Lp(a)and clinical events(hazard ratio:0.73;95%CI:0.43-1.24;P=0.239)in the multivariate Cox regression analysis during a mean follow-up time of 3.16±2.74 years.Conclusions Elevated Lp(a)level was an independent predictor of severe AS by echocardiography in the Chinese population,but was not associated with the increased risk of AVR and cardiac death,suggesting that Lp(a)levels might be helpful in the risk stratification of patients with CAVS.
文摘目的研究维持性血液透析(maintenance hemodialysis,MHD)患者血浆致动脉硬化指数(atherogenic index of plasma,AIP)、淋巴细胞与单核细胞比值(lymphocyte/monocyte ratio,LMR)与腹主动脉钙化(abdominal aortic calcification,AAC)的相关性,并构建风险预测模型。方法选取2023年5月1日─2024年4月30日在首都医科大学附属北京潞河医院郎府院区血液净化中心接受MHD治疗的患者。通过单因素及多因素Logistic回归分析来确定ACC的危险因素,建立列线图,并进行内部验证。结果共纳入158例MHD患者,分为AAC组(n=106)和非AAC组(n=52);AAC组的年龄(F=1.325,P<0.001)、校正钙(F=0.343,P=0.016)、AIP(F=8.726,P=0.003)、合并糖尿病(F=9.287,P=0.002)高于非AAC组;透析时长(F=3.681,P=0.007)、血白蛋白(F=3.287,P=0.002)、血磷(F=0.344,P=0.018)、LMR(F=1.824,P=0.022)低于非AAC组。多因素Logistic回归分析发现高龄(OR=1.071,95%CI:1.034~1.108,P<0.001)、合并糖尿病(OR=3.346,95%CI:1.428~7.843,P=0.005)、高AIP(OR=1.176,95%CI:1.041~1.33,P=0.009)、低LMR(OR=0.777,95%CI:0.614~0.983,P=0.036)是MHD患者发生AAC的独立危险因素。绘制列线图,计算C-index为0.834(95%CI:0.769~0.899),说明该列线图模型的区分能力较好。绘制校准曲线,模拟曲线和实际曲线绝对误差为0.029,说明模型具有较强的一致性。结论对于MHD患者来说,高龄、合并糖尿病、高AIP、低LMR是MHD患者发生AAC的独立危险因素。依据年龄、糖尿病、AIP、LMR构建的风险预测模型有很好的预测效能。
文摘目的探讨超敏C反应蛋白与白蛋白比值(hypersensitive C reactive protein to albumin ratio,CAR)与维持性血液透析(maintenance hemodialysis,MHD)患者腹主动脉钙化及全因死亡的相关性。方法选择2023年1月─2024年2月在首都医科大学附属北京潞河医院血液净化中心进行治疗的MHD患者为研究对象。收集符合纳入标准的患者的基本信息、规律透析治疗3个月后的生化指标、腹主动脉钙化及全因死亡情况。分析CAR与腹主动脉钙化的相关性,采用受试者工作曲线(ROC)分析CAR对腹主动脉钙化的诊断价值,采用Logistic回归分析CAR与全因死亡的关系。结果共纳入204例患者,其中腹主动脉钙化患者155例(75.98%),死亡患者11例(5.39%)。腹主动脉钙化组患者CAR高于非钙化组(Z=3.105,P=0.002)。Spearman相关性分析显示CAR与腹主动脉钙化呈正相关(r=0.218,P=0.002)。CAR诊断腹主动脉钙化的cutoff值为0.02 mg/g,敏感性为92.9%,特异性为36.7%,曲线下面积为0.647(95%CI:0.554~0.741,P=0.002)。Logistic回归分析显示年龄、透析龄、HbAlc是腹主动脉钙化的独立危险因素(OR=1.074、1.015、1.881,95%CI:1.040~1.110、1.007~1.024、1.188~2.978,P<0.001、<0.001、0.001),CAR是全因死亡的独立危险因素(OR=5.393,95%CI:1.089~26.699,P=0.039)。结论CAR与腹主动脉钙化呈正相关,CAR有助于腹主动脉钙化的诊断,且CAR是全因死亡的独立危险因素。
文摘目的系统性分析我国维持性血液透析(maintenance hemodialysis,MHD)患者并发腹主动脉钙化(abdominal aorta calcification,AAC)的危险因素。方法通过计算机对PubMed、Embase、Web of Science、中国知网、中国生物医学文献数据库CBM、万方等数据库检索关于中国MHD患者并发AAC危险因素的文献(时限为建库至2023年5月),采用纽卡斯尔-渥太华量表(Newcastle-Ottawa scale,NOS)、美国卫生保健质量和研究机构评价标准(agency for healthcare research and quality,AHRQ)进行方法学文献质量评价。采用RevMan 5.3软件进行Meta分析。结果共纳入15篇文献,其中10篇中文文献,5篇英文文献,包含2848例研究对象。Meta分析结果显示高龄(OR=1.080,95%CI:1.050~1.110,P<0.001)、长透析龄(OR=1.020,95%CI:1.010~1.040,P=0.008)、吸烟(OR=1.900,95%CI:1.440~2.500,P<0.001)、高体质量指数(body mass index,BMI)(OR=1.200,95%CI:1.050~1.110,P=0.001)、血钙升高(OR=14.140,95%CI:7.340~27.260,P<0.001)、血磷升高(OR=6.010,95%CI:2.040~17.750,P=0.001)、甲状旁腺激素升高(OR=1.310,95%CI:1.010~1.700,P=0.040)以及血镁(OR=0.490,95%CI:0.400~0.590,P<0.001)、25羟基维生素D3降低(OR=0.760,95%CI:0.610~0.950,P=0.020)为MHD患者并发AAC的危险因素。结论维持性血液透析患者并发腹主动脉钙化的影响因素较多,应重点关注高危人群,进行针对性、个性化干预,延缓MHD患者腹主动脉钙化的进展。
