Morphology of coronary atherosclerotic lesions in patients with end-stage renal failure
Morphology of coronary atherosclerotic lesions in patients with end-stage renal failure
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DOI：
10.1093/ndt/15.2.218
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发表时间：
2000-02-01
影响因子：
6.1
通讯作者：
Amann, K
中科院分区：
文献类型：
--
作者：
Schwarz, U;Buzello, M;Amann, K
背景资料。心源性死亡率过高是肾功能衰竭的一个众所周知的特征。冠心病是常见的疾病，尿毒症患者冠状动脉斑块的自然病史不同的可能性被提出。我们评估了终末期肾功能衰竭患者的冠状动脉形态，并将其与匹配的非尿毒症对照患者的冠状动脉进行了比较。尸检确定了54例符合纳入标准的患者：终末期肾病患者(n=27)；对照组，非肾性冠状动脉疾病患者(n=27)。在尸检时，所有三支冠状动脉均在相应的位置制备：(I)定性分析(造影术后)，(Ii)内膜和中层厚度的定量测量(平面法)，(Iii)冠状动脉斑块的免疫组织化学分析和(Iv)选定的钙化斑块的X射线衍射。冠状动脉定性分析显示终末期肾功能衰竭患者冠状动脉钙化斑块明显增多。非尿毒症患者的斑块多为纤维动脉粥样硬化性斑块。尿毒症患者冠状动脉中层厚度明显增加(187+/-53微米比135+/-29微米)，内膜厚度有增加趋势(158+/-38微米比142+/-31微米)，但差异无统计学意义。斑块面积(4.09+/-1.50 mm(2)vs4.39+/-0.88 mm(2))在两组相似。然而，在终末期肾病患者中，管腔面积显著降低。免疫组织化学分析显示，这些晚期斑块在尿毒症和非尿毒症患者冠状动脉内的细胞浸润物没有显著差异。终末期肾功能衰竭患者的冠状动脉斑块的特点是中层厚度增加和明显的钙化。与以前的观点相反，与非尿毒症对照相比，最显著的区别不是斑块的大小，而是斑块的组成。斑块内钙的沉积可能是尿毒症患者高并发症发生率的原因之一。
Background. An excessive rate of cardiac death is a well-known feature of renal failure. Coronary heart disease is frequent and the possibility has been raised that the natural history of the coronary plaque is different in uraemic patients. We assessed the morphology of coronary arteries in patients with end-stage renal failure and compared them with coronary arteries of matched non-uraemic control patients.Methods. Fifty-four cases were identified at autopsy who met the inclusion criteria: cases, end-stage renal disease (n=27); controls, non-renal patients with coronary artery disease (n=27). At autopsy all three coronary arteries were prepared at corresponding sites for investigations: (i) qualitative analysis (after Stary), (ii) quantitative measurements of intima and media thickness (by planimetry), (iii) immunohistochemical analysis of the coronary plaques and (iv) X-ray diffraction of selected calcified plaques.Results. Qualitative analysis of the coronary arteries showed significantly more calcified plaques of coronary arteries in patients with end-stage renal failure. Plaques of non-uraemic patients were mostly fibroatheromatous. Media thickness of coronary arteries was significantly higher in uraemic patients (187+/-53 mu m vs 135+/-29 mu m in controls) and intima thickness tended to be higher (158+/-38 mu m vs 142+/-31 mu m) but this difference was not statistically significant. Plaque area (4.09+/-1.50 mm(2) vs 4.39+/-0.88 mm(2)) was comparable in both groups. Lumen area, however, was significantly lower in end-stage renal patients. Immunohistochemical analysis of the cellular infiltrate in coronary arteries showed no major differences in these advanced plaques of uraemic and non-uraemic subjects.Conclusion. Coronary plaques in patients with endstage renal failure are characterized by increased media thickness and marked calcification. In contrast to the previous opinion the most marked difference compared to non-uraemic controls does not concern the size, but the composition of the plaque. Deposition of calcium within the plaques may contribute to the high complication rate in uraemic patients.