Coronary Artery Calcification And Autonomic Nervous System In Patients With Maintenance Hemodialysis

Research background and purpose:Mortality in end-stage renal failure patients remains very high.The average survival time of dialysis patients is less than 5 years,and more than half of them die from cardiovascular disease.Coronary calcification is an important cause of poor prognosis of cardiovascular disease.The incidence of coronary calcification in dialysis patients is as high as 80%,but its mechanism is still unclear and there is no effective intervention.Autonomic dysfunction is a common complication in dialysis patients,and autonomic nervous system involvement in bone metabolism and bone remodeling has been confirmed by many studies.It has been proved that vascular calcification is an active process similar to that of skeletal osteogenesis.Does the autonomic nervous system also participate in this active process? Obviously,the exploration of this unknown field has important theoretical value and clinical significance.To this end,this study intends to analyze the relationship between coronary calcification scores and heart rate variability(HRV)in hemodialysis patients,to explore the correlation between coronary artery calcification and autonomic dysfunction,to provide a clinical evidence for the role of autonomic nervous system in cardiovascular calcification,and also provides new ideas for effective intervention of cardiovascular calcification in dialysis patients.Materials and Methods:It was a cross-sectional observation study.49 patients undergoing maintenance hemodialysis were enrolled from January 2018 to July 2019 in the Western Theater General Hospital,and 33 health volunteers were selected as the control group.The related demographic data were collected and we test serum calcium,serum phosphorus,highsensitivity C-reactive protein,hemoglobin,serum albumin,Intact parathyroid hormone,etc;320CT coronary artery volume scan and Agatston scoring software calcification score,then divided into four groups according to CACs(CACs <10,CACs 11~100,CACs101~400,CACs >400).The 12-lead dynamic electrocardiogram was used for short-term(5minutes)measurement.After the human-machine dialogue cleared the interference and ectopic beats,to obtain HRV data(SDNN,r MSSD,p NN50,HF,LF,LF/HF,VLF)through computer software,and the relevant results were statistically.Result:1.Coronary artery calcification in the MHD group accounted for 67.34%,which was higher than 12.12% in the control group,the difference was statistically significant(P <0.01).The coronary calcification in the MHD group mainly involved the left anterior descending artery(63.20%).2.Compared with the healthy control group,,the levels of HF,LF,VLF,SDNN,LF / HF were significantly lower than those in the healthy control group(P <0.05).and the levels of hemoglobin and serum albumin in MHD patients were significantly lower(P <0.05).3.Coronary artery calcification and LF,VLF,SDNN were negatively correlated(all P <0.05),In HRV correlation analysis,It was correlated with hemoglobin,triglycerides,calcium and phosphorus product,age,and diastolic blood pressure(P <0.05).and there was no correlation between CAC and hs-CRP and i PTH,so does HRV.In multivariate ordinal logistic regression analysis,coronary calcification scores is associated with LF(OR =1.015),HF(OR = 0.983),and LF / HF(OR = 0.375)(all P <0.05).Conclusions:1.Coronary artery calcification is more common in maintenance hemodialysis patients,mainly involving the left anterior descending coronary artery;2.MHD patients have lower HRV,it Suggested autonomic dysfunction.and related to hemoglobin,age,calcium and phosphorus product,and diastolic blood pressure;3.Coronary artery calcification was negatively correlated with LF,VLF and SDNN,The severity of coronary calcification scores is associated with HF,LF,LF / HF,it suggested that atonomic dysfunction is closely related to coronary calcification.