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摘要: 目的 探讨急性心肌梗死(AMI)患者主动脉瓣钙化(AVC)、二尖瓣环钙化(MAC)、心脏瓣膜钙化(CVC)的相关因素。方法 连续入选2010年1月—2018年12月于北京大学第一医院心内科住院并留取生物样本的AMI患者911例，所有研究对象均完成超声心动图钙化评价。按主动脉瓣和二尖瓣环是否钙化对患者进行分组，分别分析AVC和MAC的影响因素。同时将患者分为无瓣膜钙化组、单瓣膜钙化组和双瓣膜钙化组，分析CVC的影响因素。结果 多因素回归分析表明，年龄≥65岁(OR=3.21，95%CI：2.39~4.32，P < 0.001)、糖尿病(OR=1.35，95%CI：1.00~1.81，P=0.047)、高血压(OR=1.38，95%CI：1.01~1.89，P=0.046)、肾功能不全(OR=1.74，95%CI：1.08~2.81，P=0.024)与AVC相关；年龄≥65岁(OR=5.37，95%CI：2.91~9.93，P < 0.001)、糖尿病(OR=1.83，95%CI：1.10~3.04，P=0.020)、肾功能不全(OR=2.55，95%CI：1.35~4.82，P=0.004)与MAC相关；年龄≥65岁(OR=3.68，95%CI：2.75~4.93，P < 0.001)、糖尿病(OR=1.57，95%CI：1.18~2.09，P=0.002)、肾功能不全(OR=2.14，95%CI：1.34~3.41，P=0.001)与CVC相关。结论 年龄、糖尿病及肾功能不全与AMI患者CVC相关，不同瓣膜钙化的相关因素并不完全相同。Abstract: Objective To investigate the related factors of cardiac valve calcification(CVC), aortic valve calcification(AVC), and mitral annulus calcification(MAC) in acute myocardial infarction(AMI) patients.Methods A total of 911 patients with AMI who were admitted to the Department of Cardiology at Peking University First Hospital from January 2010 to December 2018 were included consecutively. All patients had biological samples, and completed echocardiography calcification evaluation. Patients were grouped according to whether the aortic valve and mitral valve were calcified, then the related factors of AVC and MAC were analysed respectively. Simultaneously, patients were divided into the non-valve calcification group, single-valve calcification group, and double-valve calcification group, and the related factors of CVC were analysed.Results Regression analysis found that age ≥ 65 years old(OR=3.21, 95%CI: 2.39-4.32, P < 0.001), diabetes(OR=1.35, 95%CI: 1.00-1.81, P=0.047), hypertension(OR=1.38, 95%CI: 1.01-1.89, P=0.046), and renal insufficiency(OR=1.74, 95%CI: 1.08-2.81, P=0.024) were associated with AVC; Age ≥ 65 years old(OR=5.37, 95%CI: 2.91-9.93, P < 0.001), diabetes(OR=1.83, 95%CI: 1.10-3.04, P=0.020), and renal insufficiency(OR=2.55, 95%CI: 1.35-4.82, P=0.004) were associated with MAC; Age ≥ 65 years old(OR=3.68, 95%CI: 2.75-4.93, P < 0.001), diabetes(OR=1.57, 95%CI: 1.18-2.09, P=0.002), and renal insufficiency(OR=2.14, 95%CI: 1.34-3.41, P=0.001) were associated with CVC.Conclusion Age, diabetes, and renal insufficiency are associated with AVC in AMI patients. The factors related to calcification of different valves are not completely the same.
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表 1 研究人群特征
Table 1. Clinical data of all included patients
例(%), X ± S, M(P25, P75) 项目 总体(911例) 主动脉瓣 二尖瓣环 无钙化(533例) 钙化(378例) P 无钙化(830例) 钙化(81例) P 年龄/岁 63.25±12.45 59.63±12.09 68.36±11.11 < 0.001 62.37±12.26 72.28±10.71 < 0.001 女性 217(23.82) 105(19.70) 112(29.63) < 0.001 182(21.93) 35(43.21) < 0.001 吸烟 541(59.39) 337(63.23) 204(53.97) 0.005 508(61.20) 33(40.74) < 0.001 饮酒 325(35.68) 212(39.77) 113(29.89) 0.002 306(36.87) 19(23.46) 0.016 高血压 611(67.07) 331(62.10) 280(74.07) < 0.001 546(65.78) 65(80.25) 0.008 脂代谢紊乱 544(59.71) 326(61.16) 218(57.67) 0.290 490(59.04) 54(66.67) 0.181 心房颤动 48(5.27) 19(3.56) 29(7.67) 0.006 43(5.18) 5(6.17) 0.703 糖尿病 388(42.59) 204(38.27) 184(48.68) 0.002 337(40.60) 51(62.96) < 0.001 脑血管病 142(15.59) 69(12.95) 73(19.31) 0.009 118(14.22) 24(29.63) < 0.001 肾功能不全 93(10.21) 40(7.50) 53(14.02) 0.001 73(8.80) 20(24.69) < 0.001 心肌梗死类型 0.362 < 0.001 NSTEMI 514(56.42) 294(55.16) 220(58.20) 448(53.98) 66(81.48) STEMI 397(43.58) 239(44.84) 158(41.80) 382(46.02) 15(18.52) 肌酐/(μmol/L) 82.00(72.00，98.57) 81.00(71.10，95.30) 85.00(73.00，103.78) 0.026 82.00(71.70，96.95) 90.70(75.90，115.00) 0.003 TC/(mmol/L) 4.22±1.13 4.23±1.12 4.21±1.15 0.871 4.25±1.13 3.96±1.02 0.033 TG/(mmol/L) 1.35(0.99，2.01) 1.43(1.02，2.10) 1.29(0.96，1.79) < 0.001 1.36(1.00，2.01) 1.22(0.86，1.81) 0.033 HDL-C/(mmol/L) 0.94±0.23 0.94±0.23 0.94±0.23 0.899 0.94±0.23 0.95±0.23 0.792 LDL-C/(mmol/L) 2.56±0.89 2.55±0.89 2.58±0.88 0.622 2.58±0.90 2.33±0.72 0.016 血钙/(mmol/L) 2.23±0.13 2.24±0.13 2.21±0.14 < 0.001 2.23±0.13 2.22±0.13 0.315 血磷/(mmol/L) 1.07±0.26 1.06±0.24 1.07±0.29 0.497 1.06±0.26 1.13±0.23 0.027 钙磷乘积/(mol/L) 29.54±7.59 29.53±6.99 29.55±8.35 0.967 29.39±7.63 31.06±7.00 0.059 入院前用药 抗血小板药 279(20.63) 156(29.32) 123(32.63) 0.287 245(29.59) 34(41.98) 0.021 降压药 493(54.24) 262(49.16) 232(61.38) < 0.001 437(52.65) 57(70.37) 0.002 降脂药 216(23.79) 121(22.70) 95(25.13) 0.395 187(22.53) 29(35.80) 0.007 降糖药 281(30.98) 150(28.14) 131(34.66) 0.036 246(29.64) 35(43.21) 0.012 
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表 2 AVC和MAC相关因素的多因素回归分析
Table 2. Results of multivariate regression analysis for related factors of AVC and MAC
因素 AVC MAC OR(95%CI) P OR(95%CI) P 年龄≥65岁 3.21(2.39~4.32) < 0.001 5.37(2.91~9.93) < 0.001 女性 1.18(0.84~1.66) 0.348 1.64(0.97~2.77) 0.066 糖尿病 1.35(1.00~1.81) 0.047 1.83(1.10~3.04) 0.020 高血压 1.38(1.01~1.89) 0.046 1.18(0.64~2.18) 0.594 肾功能不全 1.74(1.08~2.81) 0.024 2.55(1.35~4.82) 0.004 脂代谢紊乱 0.87(0.63~1.20) 0.402 1.26(0.71~2.24) 0.437 降脂药 1.14(0.79~1.66) 0.481 1.47(0.82~2.66) 0.200 钙磷乘积 1.00(0.98~1.02) 0.790 1.01(0.98~1.04) 0.423
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表 3 CVC各组特征
Table 3. Clinical data of CVC groups
例(%), X ± S, M(P25, P75) 项目 总体(911例) 无瓣膜钙化组(513例) 单瓣膜钙化组(337例) 双瓣膜钙化组(61例) P 年龄/岁 63.25±12.45 59.30±11.99 67.39±11.06 73.64±10.05 < 0.001 女性 217(23.82) 96(18.71) 95(28.19) 26(42.62) < 0.001 吸烟 541(59.39) 329(64.13) 187(55.49) 25(40.98) < 0.001 饮酒 325(35.68) 208(40.55) 102(30.27) 15(24.59) 0.002 高血压 611(67.07) 316(61.60) 245(72.70) 50(81.97) < 0.001 脂代谢紊乱 544(59.71) 309(60.23) 198(58.75) 37(60.66) 0.573 心房颤动 48(5.27) 18(3.51) 26(7.72) 4(6.56) 0.024 糖尿病 388(42.59) 187(36.45) 167(49.55) 34(55.74) < 0.001 脑血管病 142(15.59) 64(12.48) 59(17.51) 19(31.15) < 0.001 肾功能不全 93(10.21) 38(7.41) 37(10.98) 18(29.51) < 0.001 心肌梗死类型 < 0.001 NSTEMI 514(56.42) 278(54.19) 186(55.19) 50(81.97) STEMI 397(43.58) 235(45.81) 151(44.81) 11(18.03) 肌酐/(μmol/L) 82.00(72.00，98.57) 81.00(71.00，95.40) 82.00(72.20，98.00) 97.00(78.23，128.69) 0.024 TC/(mmol/L) 4.22±1.13 4.23±1.11 4.27±1.17 3.89±0.98 0.058 TG/(mmol/L) 1.35(0.99，2.01) 1.43(1.02，2.10) 1.31(1.00，1.80) 1.17(0.86，1.70) 0.001 HDL-C/(mmol/L) 0.94±0.23 0.94±0.23 0.95±0.23 0.94±0.22 0.920 LDL-C/(mmol/L) 2.56±0.89 2.55±0.89 2.61±0.91 2.33±0.69 0.077 血钙/(mmol/L) 2.23±0.13 2.24±0.13 2.21±0.13 2.22±0.14 < 0.001 血磷/(mmol/L) 1.07±0.26 1.06±0.25 1.06±0.29 1.14±0.25 0.077 钙磷乘积/(mol/L) 29.54±7.59 29.53±7.06 29.20±8.30 31.51±7.50 0.091 入院前用药 抗血小板药 279(20.63) 146(28.52) 109(32.44) 24(39.34) 0.152 降压药 493(54.24) 250(48.73) 199(59.05) 45(73.77) < 0.001 降脂药 216(23.79) 114(22.22) 80(23.74) 22(36.07) 0.056 降糖药 281(30.98) 138(26.90) 120(35.61) 23(37.70) 0.013
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表 4 CVC相关因素的logistic回归分析
Table 4. Logistic regression analysis for related factors of CVC
因素 单因素分析 多因素分析 OR(95%CI) P OR(95%CI) P 年龄≥65岁 4.05(3.08~5.32) < 0.001 3.68(2.75~4.93) < 0.001 女性 1.99(1.48~2.68) < 0.001 1.36(0.98~1.89) 0.067 糖尿病 1.78(1.37~2.31) < 0.001 1.57(1.18~2.09) 0.002 高血压 1.82(1.37~2.42) < 0.001 1.35(0.99~1.85) 0.054 肾功能不全 2.44(1.59~3.74) < 0.001 2.14(1.34~3.41) 0.001 脂代谢紊乱 0.96(0.74~1.25) 0.766 0.96(0.70~1.30) 0.785 降脂药 1.28(0.95~1.73) 0.107 1.22(0.86~1.75) 0.268 钙磷乘积 1.00(0.99~1.02) 0.605 1.00(0.98~1.02) 0.848
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