Coronary artery calcification in patients with CRF not undergoing dialysis
Coronary artery calcification in patients with CRF not undergoing dialysis
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DOI：
10.1053/j.ajkd.2004.07.022
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发表时间：
2004-12-01
影响因子：
13.2
通讯作者：
Andreucci, VE
中科院分区：
文献类型：
--
作者：
Russo, D;Palmiero, G;Andreucci, VE
背景资料：冠状动脉钙化（CAC）与冠状动脉粥样硬化的程度相关，因此，与心血管事件的风险增加。CAC在尿毒症患者中比在一般人群中更常见。几乎所有关于CAC的数据都与接受透析治疗的患者有关。本研究评价了尚未接受透析治疗的慢性肾功能衰竭（CRF）患者中CAC的患病率和程度。方法选择非透析治疗的慢性肾功能衰竭患者，并与正常对照组（健康志愿者和肾功能正常的原发性高血压患者）进行比较。患者和对照组均无症状，既往无心肌梗死、冠状动脉搭桥手术或血管成形术史。排除糖尿病患者。对患者和对照组的临床特征、生化检查结果（包括同型半胱氨酸血症和C反应蛋白水平）以及血清钙、磷和全段甲状旁腺激素（IPTH）浓度进行评价。通过螺旋计算机断层扫描（CT）搜索CAC并进行评分。为了评估CAC进展率，在一些患者中重复螺旋CT。结果：85例患者和55名对照进行了研究。患者年龄为52 ± 13岁，CRF持续时间为6.3 ± 5.6年，肾小球滤过率为33.0 ± 16.0 mL/min（0.55 +/- 0.27 mL/s），血清钙水平为9.5 +/- 0.5 mg/dL（2.37 +/- 0.12 mmol/L），血清磷水平4.1 +/- 0.9 mg/dL（1.32 +/- 0.29 mmol/L），血清iPTH水平143 +/- 121 pg/mL（ng/L）。40%的患者和13%的对照者发现CAC;患者的钙化评分为422 +/- 634，对照者为43.9 +/- 33。只有年龄（P < 0.001）是CAC的预测因素。在进行重复评分的患者中（平均7.9个月后），10例患者中有8例钙化评分增加（从383 +/- 627增加到682 +/- 890）。结论：CAC已经存在于CRF的早期阶段; CRF患者的患病率高于对照组，但低于透析患者的患病率。血清钙、磷、iPTH和炎症标志物浓度不能预测CAC的出现或进展。
Background: Coronary artery calcification (CAC) correlates with the extent of coronary atherosclerosis and, consequently, with an increased risk for cardiovascular events. CAC is more frequent in uremic patients than in the general population. Nearly all data about CAC relate to patients on dialysis therapy. This study evaluates the prevalence and extent of CAC in patients with chronic renal failure (CRF) not yet on dialysis therapy. Methods Consecutive outpatients with CRF not on dialysis therapy were enrolled and compared with controls (ie, healthy volunteers and patients with essential hypertension with normal renal function). Patients and controls were asymptomatic and had no previous history of myocardial infarction, coronary bypass surgery, or angioplasty. Patients with diabetes were excluded. Clinical characteristics, biochemical test results (included homocysteinemia and C-reactive protein level), and serum concentrations of calcium, phosphorus, and intact parathyroid hormone (IPTH) were evaluated in patients and controls. CACs were searched for and scored by means of spiral computed tomography (CT). To assess the CAC progression rate, spiral CT was repeated in some patients. Results: Eighty-five patients and 55 controls were studied. Patients were aged 52 +/- 13 years and had a CRF duration of 6.3 +/- 5.6 years, glomerular filtration rate of 33.0 +/- 16.0 mL/min (0.55 +/- 0.27 mL/s), serum calcium level of 9.5 +/- 0.5 mg/dL (2.37 +/- 0.12 mmol/L), serum phosphorus level of 4.1 +/- 0.9 mg/dL (1.32 +/- 0.29 mmol/L), and serum iPTH level of 143 +/- 121 pg/mL (ng/L). CAC was found in 40% of patients and 13% of controls; calcification scores were 422 +/- 634 in patients and 43.9 +/- 33 in controls. Only age (P < 0.001) was a predictor of CAC. In patients with a repeated score performed (after a mean of 7.9 months), calcification scores increased (from 383 +/- 627 to 682 +/- 890) in 8 of 10 patients. Conclusion: CAC is already present in the early phase of CRF; the prevalence is greater in patients with CRF than in controls, but less than that reported in dialysis patients. Serum concentrations of calcium, phosphorus, iPTH, and inflammation markers do not predict the appearance or progression of CAC.