ABSTRACT
Objective:To explore the incidence, influencing factors and prognostic value of cardiac valve calcification (CVC) in chronic kidney disease (CKD) non-dialysis patients.Methods:The non-dialysis patients with CKD stage 1-5 who were hospitalized and underwent echocardiography in the Department of Nephrology, Xuanwu Hospital, Capital Medical University from January 1, 2018 to December 31, 2019 were retrospectively admitted. The patients were divided into CVC group and non-CVC group, and the clinical data were compared between the two groups. The deadline for follow-up was November 1, 2021, and the follow-up end point event was all-cause mortality. Logistic regression model was used to analyze the risk factors of CVC in patients with CKD, and Cox proportional hazards regression model was used to analyze the risk factors of all-cause mortality in patients with CKD.Results:A total of 563 patients with CKD were enrolled in the study, with age of (59.49±13.97) years old, and 352 males (62.52%). There were 325 patients (57.73%) with CKD stage 1-3 and 238 patients (42.27%) with CKD stage 4-5. The incidence of CVC in CKD stage 1-5 patients was 32.32%(182/563). Aortic valve calcification occurred in 30.73%(173/563), mitral valve calcification occurred in 9.77% (55/563), double valve (mitral and aortic valve) calcification occurred in 8.35% (47/563), and tricuspid valve calcification occurred in 0.18%(1/563). Age (t=12.223, P<0.001) and the proportions of CKD stage 4-5 ( χ 2=10.854, P=0.001), hypertension ( χ 2=7.811, P=0.005), diabetes ( χ 2=8.424, P=0.004), hyperlipidemia ( χ 2=9.331, P=0.002), and taking statins ( χ 2=4.868, P=0.027) in CVC group were significantly higher than those in non-CVC group. Total cholesterol (t=2.243, P=0.025), low density lipoprotein cholesterol (t=2.025, P=0.043), platelet count (t=2.230, P=0.026) and estimated glomerular filtration rate (t=8.630, P<0.001) in CVC group were lower than those in the non-CVC group. Logistic regression analysis results showed that age≥60 years old (≥60 years old/<60 years old, OR=7.412, 95% CI 4.514-12.170, P<0.001), CKD stage 4-5 (stage 4-5/stage 1-3, OR=2.791, 95% CI 1.730-4.505, P<0.001) and hyperlipidemia ( OR=5.241, 95% CI 3.283-8.367, P<0.001) were the independent influencing factors of CVC in patients with CKD. Five hundred and sixty-three patients were followed up for an average of 26 months, including 68 cases (12.08%) of death, 436 cases (77.44%) of survival and 59 cases (10.48%) of loss to follow-up. Multivariate Cox regression analysis results showed that age≥60 years old (≥60 years old/<60 years old, HR=2.157, 95% CI 1.127-4.127, P=0.020), serum albumin<30 g/L (<30 g/L/≥30 g/L, HR=1.923, 95% CI 1.037-3.568, P=0.038) and double valve calcification (double valve calcification/no valve calcification, HR=2.516, 95% CI 1.279-4.950, P=0.008) were the independent influencing factors of all-cause death in patients with CKD. Conclusions:CVC accounts for 32.32% in non-dialysis patients with CKD stage 1-5. Older age, worse renal function and hyperlipidemia are the independent risk factors of CVC in CKD patients. Older age, hypoproteinemia and double valve calcification are the independent risk factors of all-cause death in patients with CKD.
ABSTRACT
Objective To acquire some related data of surgical approach through brain superior temporal sulcus to temporal horn of lateral ventricle by MRI volume rendering, and to orientate the point of superior temporal sulcus on the lateral surface which is closest to temporal horn of lateral ventricle,and to find out the best entrance point of surgical approach through superior temporal sulcus to temporal horn of lateral ventricle.Methods 120 adult cases of MRI scanning specimens were chosen for measurement. MRI volume rendering technology was used to rebuild the brain 3D model for the measurement of the full length of superior temporal sulcus S1 .Then cutting along the prependicular to the direction of the long axis of the temporal lobe with 1.0 mm spacings,the coronal sections were obtained,and the distance from superior temporal sulcus to temporal horn of lateral ventricle was ordinally measured and the shortest distance S2 was made sure.And the depth of superior temporal sulcus S3 was detected. The corresponding point on the surface of the brain at superior temporal sulcus according to the point leading the shortest distance S4 was determined. The ratio of S4 to S1 M was calculated. The angle between the shortest distance and median sagittal plane asαwas determined.All the samples were measured on both sides of the brain and all the data were compared.Results The S1 of the 120 cases was (159.56 ± 17.55)mm on the left and (164.35± 15.07)mm on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);the S2 was (8.18±0.96)mm on the left and (7.81±0.90)mm on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);the S3 was (12.19±1.43)mm on the left and (11.57± 1.33)mm on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);the S4 was (100.88±16.09)mm on the left and (104.15±14.49)mm on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);the M was (0.63 ±0.07)on the left and (0.63 ±0.06)on the right,there was no statistical difference between two cerebral hemispheres(P>0.05);theαwas (55.80±3.64)°on the left and (56.46±4.17)°on the right,there was no statistical difference between two cerebral hemispheres(P>0.05). Conclusion The point at the front side 3/5 of superior temporal sulcus may be the ideal surgical approach entrance point.The distance from the point to temporal horn of lateral ventricle is shortest.It indicates that the approach can reduce the damage of brain tissue.