Atherosclerosis and vascular calcification are independent predictors of left ventricular hypertrophy in chronic haemodialysis patients.
Atherosclerosis and vascular calcification are independent predictors of left ventricular hypertrophy in chronic haemodialysis patients.
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DOI：
10.1093/ndt/gfh611
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发表时间：
2005-04
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通讯作者：
A. Yildiz;E. Memisoglu;H. Oflaz;H. Yazıcı;H. Pusuroğlu;V. Akkaya;F. Erzengin;Savaş M Tepe
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作者：
A. Yildiz;E. Memisoglu;H. Oflaz;H. Yazıcı;H. Pusuroğlu;V. Akkaya;F. Erzengin;Savaş M Tepe
背景慢性血液透析（HD）患者中常见加速的动脉粥样硬化和血管钙化。在这项研究中，我们的目的是探讨血液透析患者左心室肥厚（LVH）与动脉粥样硬化和血管钙化的关系，通过电子束计算机断层扫描（EBCT）测量。方法对118例HD患者（男52例，女66例，平均年龄46 ± 13岁）进行血尿素氮（BUN）、肌酐（Cr）、白蛋白（ALB）、血红蛋白（Hb）、C反应蛋白（CRP）、纤维蛋白原（Fg）等生化指标的检测，并对其中85例患者进行超声心动图、高分辨率B型颈动脉超声和EBCT检查。在两条颈动脉的四个不同部位（总动脉、球动脉、内动脉和外动脉）测量狭窄程度。颈动脉斑块评分通过对所有位置测量的狭窄程度求和来计算。结果89例患者（75%）检出左室肥厚。斑块阳性患者的左心室质量指数（LVMI）高于斑块阴性患者（175+/-59 vs 143+/-46 g/m2，P = 0.003）。LVMI与收缩压相关（r = 0.62，P<0.001），脉压（r = 0.58，P<0.001），血红蛋白水平（r =-0.25，P = 0.008），颈动脉斑块评分冠状动脉钙化积分（CACS）与主动脉壁钙化积分（AWCS）分别为r = 0.34，P = 0.002和r = 0.43，P<0.001。多元线性回归分析（r = 0.76）显示，与LVMI相关的独立因素是收缩压、脉压、颈动脉粥样硬化斑块。结论冠状动脉外粥样硬化和血管钙化与HD患者LVH的发生有关。动脉粥样硬化或血管钙化的治疗是否会导致HD患者LVH的消退甚至预防仍有待观察。
BACKGROUND Accelerated atherosclerosis and vascular calcification are common in chronic haemodialysis (HD) patients. In this study, we aimed to investigate the relationship between left ventricular hypertrophy (LVH) in HD patients and atherosclerosis and vascular calcification measured by electron beam computed tomography (EBCT). METHODS In a cohort of 118 HD patients (52 male, 66 female, mean age: 46+/-13 years), we measured biochemical parameters, including BUN, creatinine, albumin, haemoglobin, C-reactive protein and fibrinogen levels, and performed echocardiography, high-resolution B-mode carotid ultrasonography and EBCT in 85 of them. The degree of stenosis was measured at four different sites (communis, bulbus, interna and externa) in both carotid arteries. Carotid plaque scores were calculated by summing the degrees of stenosis measured at all locations. RESULTS LVH was detected in 89 of the patients (75%). Plaque-positive patients had higher left ventricular mass index (LVMI) than plaque-negative patients (175+/-59 vs 143+/-46 g/m2, P = 0.003). LVMI was correlated with systolic blood pressure (r = 0.62, P<0.001), pulse pressure (r = 0.58, P<0.001), haemoglobin levels (r = - 0.25, P = 0.008), carotid plaque score (r = 0.32, P = 0.001) and coronary (CACS) and aortic wall calcification score (AWCS) (r = 0.34, P = 0.002 and r = 0.43, P<0.001, respectively). Multiple linear regression analysis (model r = 0.76) showed the independent factors related to LVMI to be systolic blood pressure, pulse pressure, CACS and presence of carotid plaques. CONCLUSION Extra-coronary atherosclerosis and vascular calcification are associated with LVH in HD patients. Whether the treatment of atherosclerosis or vascular calcification may cause regression of or even prevent LVH in HD patients remains to be seen.