Inflammation, mineral metabolism and progressive coronary artery calcification in patients on haemodialysis
Inflammation, mineral metabolism and progressive coronary artery calcification in patients on haemodialysis
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DOI：
10.1093/ndt/gfl118
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发表时间：
2006-07-01
影响因子：
6.1
通讯作者：
Han, Heon
中科院分区：
文献类型：
--
作者：
Jung, Hae Hyuk;Kim, Sang-Wook;Han, Heon
背景资料。冠状动脉钙化(CAC)是终末期肾病(ESRD)患者常见的并发症。这项研究的目的是前瞻性地评估两年期间CAC的变化，并确定可能与终末期肾病患者CAC进展相关的因素。对最初进入研究的43名稳定的血液透析患者中的40名进行了最终分析。研究人群在基线和至少12个月后(30名患者24个月，4名患者18个月，其余6名患者12个月)接受多排螺旋CT检查，得出CAC评分。为了提供对基线CAC无偏见的稳定估计，使用平方根变换的CAC分数来分析CAC的变化。随访时(P<；0.001)，CAC评分中位数为191(范围0-2403)mm(3)，增加到253(范围0-2745)mm(3)，经平方根变换后的年化变化中位数为1.48(范围-0.95-8.64)mm(3)/年。经平方根变换后的CAC积分年化变化与C反应蛋白(R=0.521，P=0.001)、磷(R=0.433，P=0.005)、钙磷乘积(R=0.394，P=0.012)呈正相关，与胎球蛋白-A(F-A)及血脂参数无相关性。即使在调整了年龄、性别和基线CAC评分后，C反应蛋白水平仍与CAC进展独立相关。这些数据表明，慢性炎症和矿物质代谢改变有助于终末期肾病患者CAC的快速进展。此外，还需要更大规模的研究来证实我们的发现。
Background. Coronary artery calcification (CAC) is an extensive and common complication in patients with end-stage renal disease (ESRD). The aim of this study was to assess prospectively the change in CAC over a 2-year period and to identify the factors that may be associated with CAC progression in ESRD patients.Methods. The final analysis was performed on 40 of 43 stable haemodialysis patients who initially entered into the study. The study population underwent multirow spiral computed tomography to derive CAC scores at baseline and after a minimum of 12 months (24 months in 30 patients, 18 months in four, and 12 months in the remaining six patients). To provide a stable estimate that was unbiased with respect to the baseline CAC, square root-transformed CAC scores were used for the analyses of the changes in CAC.Results. The median CAC score was 191 (range, 0-2403) mm(3) at baseline and increased to 253 (range, 0-2745) mm(3) at follow-up (P < 0.001) and the median annualized change in square root-transformed CAC score was 1.48 (range, -0.95-8.64) mm(3)/year. The annualized change of the square root-transformed CAC score positively correlated with the time-integrated levels of C-reactive protein (R = 0.521, P = 0.001), phosphorus (R = 0.433, P = 0.005) and calcium x phosphorus product (R = 0.394, P = 0.012), but did not correlate with the levels of fetuin-A or lipid parameters. Even after adjusting for age, gender and baseline CAC score, C-reactive protein levels were independently associated with CAC progression.Conclusion. These data suggest that chronic inflammation as well as altered mineral metabolism contributes to a rapid progression of CAC in ESRD patients. Additional, larger scale studies are required to confirm our findings.