| Objective:To observe the serum magnesium and cardiac valve calcification in patients with MHD and to explore the relationship between serum magnesium and cardiac valve calcification,and to provide new ideas for early detection,early intervention and improved prognosis.Methods:1 Subjects:149 MHD patients who were treated in blood purification center of Affiliated Hospital of Chengde Medical College from January in2015 to September in 2016,the MHD treatment period was longer than 3months,the Kt/V was greater than 1.2,and the age was greater than 18.2 Clinical and laboratory data:The patients'age,gender,kidney primary disease,combined disease,complication,dialysis age,dialysis plan and medication were recorded.All subjects were drew blood before the second round of dialysis weekly at the hungry state in order to test blood routine,blood biochemical indicators,and serum full-parathyroid hormone(iPTH)and so on.After dialysis the MHD patients were drew blood to test the blood urea nitrogen(BUN).Calculation of Kt/V and urea decline rate(URR)to evaluate the dialysis adequacy of MHD patients,and standard protein decomposition rate(nPCR)to evaluate dietary protein intake.3 CVC examination method and diagnostic criteria:The CVC condition was examined using the Philip IE33 Ultrasound System;there was a hyperechoic mitral or aortic valve(with aortic echo intensity as an internal reference point equal to or higher than the aortic echo hyperechoic)and a thickness greater than 1 mm was defined as CVC.4 Dividing group method:(1)according to the normal reference range of blood magnesium from 0.7 to 1.0mmol/L in the laboratory,it was divided into100 cases of high serum magnesium group(>1.0mmol/L),49 cases of normal serum magnesium group(0.7~1.0mmol/L),and 0 cases of low blood magnesium(<0.7mmol/L).(2)The patients with different levels of serum phosphorus were further divided into high serum magnesium group and normal serum magnesium group:98 cases of hyperphosphoremia(P>1.45mmol/L)(including 77 cases of high serum magnesium group,21 normal serum magnesium group),48 cases of normal serum phosphorus(0.87-1.45mmol/L)(22 cases of high serum magnesium group,26 cases in normal serum magnesium group),Only 3 cases of hypophosphatemia(<0.87 mmol/L)were not analyzed.(3)According to the results of echocardiography,CVC was divided into CVC group(n=98)and no CVC group(n=51)according to whether CVC.5 Statistical analysis:SPSS19.0 software was used for statistical analysis.Normally distributed measurement data are expressed as mean±standard deviation(x±s),and group comparisons are performed using t-test;non-normal measurement data are expressed as median M(1/4,3/4),and Mann-Whitney U test is compared between the two groups.;count data using?~2 test;bivariate correlation using Pearson linear correlation analysis;risk factors affecting CVC using binary logistic regression analysis.Results:1 Serum magnesium and cardiac valve calcification in patients with MHD:Among 149 MHD patients,serum magnesium average(1.08±0.16)mmol/L and 100 were high serum magnesium(67.1%),49 were normal serum magnesium(32.9%),no hypomagnesium.98 were with CVC(65.8%).There were 98 with CVC(65.8%),including 43 of MVC(28.9%),81 of AVC(54.4%),and 26 of MVC+AVC(17.5%).2 Comparison of CVC and other clinical indexes in MHD Patients with High Serum Magnesium group and Normal Serum Magnesium group 60 cases(60%)of CVC patients with high serum magnesium group(60%)were significantly lower than those of normal serum magnesium group(77.6%)(P<0.05);Serum phosphorus(1.89±0.61)mmol/L in hypermagnesemia group was significantly higher than that in normal serum magnesium group(1.58±0.59)mmol/L(P<0.05);Hb and Alb in high serum magnesium group were significantly higher than those in normal serum magnesium(P<0.05).3 Effects of serum magnesium level on CVC and other clinical indicators in MHD patients with different levels of Serum Phosphorus3.1 Comparison of CVC and Other Clinical Parameters Between High Serum Magnesium and Normal Serum Magnesium in Patients with MHD HyperphosphatemiaIn the high serum magnesium group,CVC 47 cases(61.04%)and MVC22(28.57%)were significantly lower than those in the normal serum magnesium group 18 cases(85.71%)and 12 cases(57.14%)(P<0.05);In the high serum magnesium group,AVC 39 cases(50.65%),MVC+AVC 14cases(18.18%),in the normal serum magnesium group,AVC 14cases(63.64%),and MVC+AVC 8 cases(38.10%),there was no significant difference between the two groups(P>0.05).3.2 Comparison of CVC and Other Clinical Parameters between High Serum Magnesium and Normal Serum Magnesium in Patients with MHD Normal PhosphorusIn the high serum magnesium group,CVC 12 cases(54.55%),MVC 4(18.18%),AVC 10 cases(45.45%),and MVC+AVC 2 cases(9.09%),in the normal serum magnesium group,CVC 19 cases(73.08%),MVC 8(30.77%),AVC 16cases(61.54%),and MVC+AVC 5 cases(19.23%),there was no significant difference between the two groups(P>0.05).The levels of Hb,Alb,BMI and UA in high serum magnesium group were significantly higher than those in normal serum magnesium group(P<0.05).4 Correlation analysis of serum magnesium with serum phosphorus and other clinical indexesSerum magnesium was positively correlated with serum phosphorus,Hb,Alb,UA and CREA,and the correlation coefficients respectively were 0.208,0.303,0.221 and 0.154.5 Comparison of serum magnesium and other clinical indexes between CVC group and no CVC group in patients with MHDThe serum magnesium level in the no CVC group was(1.14±0.14)mmol/L,which was significantly higher than that in the CVC group(1.06±0.15)mmol/L(P<0.05).The serum phosphorus level in the CVC group was(1.86±0.68)mmol/L,which was significantly higher than that in the no CVC group(1.65±0.46 mmol/L)(P<0.05);the CVC group 60 patients with hypermagnesemia(61.2%)were significantly lower than 40 patients with hypermagnesemia no CVC group(78.4%),and the difference was statistically significant(P<0.05);CHD patients in the CVC group were 18Cases(18.4%)were significantly higher than 3(5.9%)patients in the no CVC group,and the difference was statistically significant(?~2=4.318,P<0.05).6 Logistic regression analysis of the risk factors of valve calcification in MHD patients(1)the influence factors of CVC:serum magnesium(OR=0.364,95%CI0.197~0.673,P<0.05)had independent negative correlation with CVC,and the serum phosphorus,age and age of dialysis were independent positive correlation with CVC(P<0.05).(2)the influence factors of MVC:serum magnesium(OR=0.533,95%CI 0.312~0.912,P<0.05)had independent negative correlation with MVC;serum phosphorus and dialysis age were independent positive correlation with MVC(P<0.05).(3)the influence factors of AVC:serum magnesium(OR=0.468,95%CI 0.271~0.810,P<0.05)had independent negative correlation with AVC;serum phosphorus and age were independent positive correlation with AVC(P<0.05).(4)the influence factors of MVC+AVC:the serum magnesium(OR=0.470,95%CI 0.245~0.902,P<0.05)was negatively correlated with MVC+AVC,and the serum phosphorus was independent positive correlation with MVC+AVC(P<0.05).Conclusion:1 The level of serum magnesium and the high prevalence of high serum magnesium in patients with MHD2 The high prevalence of CVC in patients with MHD3 High serum magnesemia is an independent protective factor for CVC in patients with MHD;the appropriate increase in serum magnesium levels may reduce the incidence of CVC in MHD patients4 Hyperphosphatemia is an independent risk factor for CVC;serum magnesium is positively correlated with serum phosphorus,and magnesium inhibits CVC in hyperphosphatemic MHD. |
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