Arterial stiffening and vascular calcifications in end-stage renal disease
Arterial stiffening and vascular calcifications in end-stage renal disease
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DOI：
10.1093/ndt/15.7.1014
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发表时间：
2000-07-01
影响因子：
6.1
通讯作者：
Metivier, F
中科院分区：
文献类型：
--
作者：
Guérin, AP;London, GM;Metivier, F
背景流行病学研究已经确定主动脉僵硬度是终末期肾病（ESRD）患者心血管死亡率的独立预测因子。在这些患者中，主动脉脉搏波速度（PWV）与中膜钙化相关，但动脉钙化对大动脉粘弹性的影响尚未得到很好的表征。本研究的目的是分析稳定血液透析患者动脉钙化对动脉硬度的影响。我们研究了120例接受血液透析的稳定型ESRD患者。所有患者均接受颈总动脉（CCA）、主动脉和股动脉的B型超声检查，以确定CCA扩张性、弹性增量模量（Einc）和血管钙化的存在。所有患者均行主动脉PWV和超声心动图检查。根据动脉钙化部位的数量，对钙化的存在进行半定量分析，评分为0 ~ 4分。我们的观察结果表明，动脉和主动脉僵硬的存在和动脉钙化的程度显着影响。动脉钙化的程度是左心室后负荷增加的部分原因，并与每搏输出量呈负相关。钙化的影响与年龄和血压的作用无关。动脉钙化密度随着年龄、血液透析时间、纤维蛋白原水平和钙基磷酸盐结合剂处方剂量的增加而增加。这项研究的结果表明，ESRD患者中血管钙化的存在与大容量弹性型动脉（如主动脉和CCA）的刚度增加相关。动脉钙化的程度随着钙基磷酸盐结合剂的使用而增加。
Background. Epidemiological studies have identified aortic stiffness as an independent predictor of cardiovascular mortality in end-stage renal disease (ESRD) patients. In these patients, aortic pulse wave velocity (PWV) was associated with mediacalcosis, but the influence of arterial calcifications on the viscoelastic properties of large arteries was not well characterized. The purpose of the present study was to analyse the influence of arterial calcifications on arterial stiffness in stable haemodialysed patients.Methods. We studied 120 stable ESRD patients on haemodialysis. All patients underwent B-mode ultrasonography of common carotid artery (CCA), aorta, and femoral arteries to determine CCA distensibility, the elastic incremental modulus (Einc), and the presence of vascular calcifications. All patients underwent measurement of aortic PWV and echocardiogram. The presence of calcifications was analysed semiquantitatively as a score (0 to 4) according to the number of arterial sites with calcifications.Results. Our observations indicate that arterial and aortic stiffness is significantly influenced by the presence and extent of arterial calcifications. The extent of arterial calcifications is in part responsible for increased left ventricular afterload, and is inversely correlated with stroke volume. The influence of calcifications is independent of the role of ageing and blood pressure. Arterial calcifications density increases with age, duration of haemodialysis, the fibrinogen level, and the prescribed dose of calcium-based phosphate binders.Conclusions. The results of this study showed that the presence of vascular calcifications in ESRD patients was associated with increased stiffness of large capacity, elastic-type arteries, like the aorta and CCA. The extent of arterial calcifications increased with the use of calcium-based phosphate-binders.