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Objective: multislice CT as the gold standard of evaluation of coronary artery calcification, explore methods of assessing vascular calcification predictive value of maintenance hemodialysis (maintenance hemodialysis, MHD) patients with coronary calcification, analysis of risk factors for coronary calcification and the establishment of a predictive model of coronary calcification. Methods: The 36 cases of patients with hemodialysis centers in our hospital, underwent multislice spiral CT, echocardiography, X-plain film, pulse wave velocity checks and asked patients generally. All patients with unified extraction within a week predialysis blood for detection of 1,84-PTH and 25-hydroxyvitamin D3, while collecting line within six months before the time of the CT examination in patients with other test results, including white blood cells, hemoglobin, platelet , urea, creatinine, albumin, C-reactive protein (CRP), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), calcium, phosphorus, alkaline phosphatase (ALP), intact parathyroid hormone (iPTH), ferritin (FER). The comparison between groups using t test (normal quantitative variables), chi-square test (categorical variables), Mann-Whitney test (non-normal quantitative variables), X plain film parts and different parts of the combination of the predictive value of coronary calcification using logistic regression analysis and receiver operating characteristic curve (ROC), predict coronary calcification model using logistic regression analysis, the predictive ability of the model using ROC. The results: 1,36 MHD patients of coronary artery calcification was 88.9%, coronary artery calcification score (coronary artery calcification scores, CACs) mean 1010.472 (range :0-10761 .2) CACs = 0 points patients have 4 cases (11.11%), 0 lt; CACs patients ≤ 100 points in nine cases (25%), 100 points lt; 6 cases (16.67%) patients with CACs ≤ 400 points, 400 points lt; CACs ≤ 1000 points 7 cases (19.44%) of patients with CACs gt; 10 cases (27.78%) of 1000 patients. Unconsolidated compared in patients with diabetes or coronary heart disease, diabetes or coronary heart disease patients with higher coronary artery calcification score (P lt; 0.05). X-ray showed no calcification in patients with 5 cases (13.9%), mild calcification (1-3) patients, 11 patients (30.6%) patients with moderate calcification (4-6) in 13 patients (36.1% ), 7 cases (19.4%) patients with severe calcification (≥ 7 points). Echocardiography icon 3 patients (8.3%) presence of valvular calcification. 2, involving the left main coronary artery calcification in the left anterior descending artery, right coronary artery, coronary circumflex artery number of patients (percentage) followed by 15 cases (41.7%), 28 cases (77.8%), 28 patients (77.8%) 24 cases (66.7%), left anterior descending artery, higher than the left main coronary artery and the circumflex artery of the right coronary artery calcification score. No branch of patients with calcification in 4 cases (11.11%), calcification involving a branch in 5 cases (13.89%) patients with calcification involving the two branches of the patients in 4 cases (11.11%), calcification involving the three branches of the patients 10 cases (27.78%), calcification involving the four branches of the patients, 13 cases (36.11%), which calcification involving the three branches of the patients have a higher CACs. The relatively plain film X shown iliac artery, femoral artery, abdominal aorta, radial artery, the the finger artery calcification predictive value of the presence or absence of coronary artery calcification, OR value for 12.250,8.556,5.714,1.778,1.158, The sensitivity and specificity were 91.30% and 53.85%, 60.87% and 84.62%, 86.96% and 46.15%, 34.78% and 76.92%, 17.39% and 84.62%. Different parts of the portfolio, the iliac artery femoral artery OR value 25.667, iliac artery abdominal aortic OR = 9.778, OR = 4.167 for abdominal aortic femoral artery, iliac artery femoral artery abdominal aorta and iliac artery femoral artery abdominal aortic the radial artery finger artery OR values ??were 9.778, sensitivity and specificity were 95.65% and 53.85%, 86.96% and 38.46%, 95.65% and 30.77%, 95.65% and 30.77%, 95.65% and 30.77% . 4, using ROC variety of plain film X combination mode of CACs ≥ predictive value of 100, the largest area under the ROC curve of iliofemoral mode, AUC was 0.811. P lt; 0.05 X-plain film combination mode AUC pairwise comparison, the results suggest that these plain film X combination mode of CACs ≥ 100 predictive ability was no significant difference. 5, compared to non-calcified group (CACs = 0), the calcified group (CACs gt; 0), age, BMI and pulse pressure greater, the lower the level of 25-hydroxyvitamin D3, the difference was statistically significant; compared to coronary lower degree of calcification (CACs lt; 100) (CACs ≥ 100) older, higher predialysis blood urea nitrogen, diastolic blood pressure lower predialysis and dialysis, and is often associated with coronary heart disease, the difference was statistically significant hyperphosphatemia average CRP level, the higher the degree of coronary calcification group than the lower degree of coronary calcification group of high serum levels of 25-hydroxyvitamin D3 average lower than the degree of coronary calcification group is low, but the differences were not statistically significance. 6 single factor analysis showed coronary artery calcification score factors: age, BMI, pulse pressure before dialysis, 25 dihydroxyvitamin D3 may be related to the presence of calcifications (CACs gt; 0); age, duration of hypertension, dialysis After dialysis, diastolic blood pressure may be associated with the degree of calcification (CACs ≥ 100), the difference was statistically significant. 7 multivariate analysis, coronary artery calcification score factors results: pulse pressure, 25-hydroxyvitamin D3 is an independent risk factor for presence of CAC (CACs gt; 0), and the age of patients with CAC severity (≥ 100 CACs) an independent risk factor (P lt; 0.05). 8, into the coronary artery calcium score ≥ 100 group univariate analysis P lt; factors of 0.1 and a variety of checks established to predict maintenance hemodialysis patients with coronary calcification model: Y = 0.280 * Age 0.027 * duration of hypertension 1.406 * 4 mode shares iliac score -0.578 * are PWV formulas predict coronary calcification ROC area under the curve of 0.958 (95% CI = 0.000-1.000, P = 0.000), the cut-off point value of 7.9, formulas to predict a specificity of 92.3%, a sensitivity of 86.4%. Conclusion: MHD patients prevalence of coronary artery calcification, coronary artery calcification easier involving coronary artery to the left anterior descending coronary artery and the right coronary artery, old age, diabetes or coronary heart disease patients with higher coronary artery calcium score. To assess the maintenance hemodialysis patients with coronary artery calcification preliminary understanding of viable X-ray and X-ray examination, compared to a single site and multiple sites select anteroposterior pelvic plain film X forecast the occurrence of coronary artery calcification may be more a desirable operation more simple, the choice of the iliac artery or / and femoral artery dichotomous mode (iliac artery or femoral artery calcification namely 1, no calcification 0), can also choose the iliac arteries femoral artery 4 of 5 stars mode (left or right iliac artery calcification each 1 point, the left or the right femoral artery calcification 1, no calcification of 0, up to 4 points, 0 points). Pulse pressure, 25-dihydroxyvitamin D3 is the presence of coronary artery calcification (CACs gt; 0) were independent risk factors, age is an independent risk factor for the severity of coronary artery calcification in patients (CACs ≥ 100). 4, predictive maintenance hemodialysis patients with coronary calcification model: Y = 0.280 * Age 0.027 * duration of hypertension 1.406 * shares iliac mode score -0.578 * are PWV, when the patient's Y gt; 7.9, the patient may the presence of more than 100 points in coronary calcification score.
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