Cardiovascular calcifications in uremic patients: Clinical impact on cardiovascular function
Cardiovascular calcifications in uremic patients: Clinical impact on cardiovascular function
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DOI：
10.1097/01.asn.0000081664.65772.eb
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发表时间：
2003-09-01
影响因子：
13.6
通讯作者：
London, GM
中科院分区：
文献类型：
--
作者：
London, GM
心血管疾病是 ESRD（慢性肾病 5 期）患者死亡的主要原因。左心室肥厚和动脉疾病是血液透析患者心血管死亡的两个主要危险因素。流行病学研究表明，大导管动脉的损伤会导致慢性肾病患者的发病率和死亡率。动脉粥样硬化主要是一种内膜疾病，其特征在于存在斑块和闭塞性病变。尽管动脉粥样硬化是 ESRD 患者心血管疾病最常见的根本原因，但它仅代表对干扰衰老过程的代谢和血流动力学改变的结构反应的一种形式。 ESRD 中的动脉改变包括非闭塞性动脉重塑，伴随着血流动力学负担的增加以及与慢性尿毒症相关的体液异常。这些改变的后果与动脉粥样硬化斑块所造成的后果不同，其主要特征是动脉硬化。动脉硬化以主动脉和大动脉硬化为特征，是左心室压力超负荷和冠状动脉灌注异常的主要决定因素。动脉粥样硬化和动脉硬化经常并存，其特征是 ESRD 患者内膜和内侧高度钙化。钙化程度和动脉硬化程度是死亡率的独立预测因素。对 ESRD 患者的研究表明，动脉僵硬度的减弱可以对生存产生有利的影响，与左心室肥厚的消退相关。无钙、无金属的磷酸盐结合剂（例如司维拉姆）可以降低钙化分数。
Cardiovascular disease is the leading cause of mortality among patients with ESRD (chronic kidney disease stage 5). Left ventricular hypertrophy and arterial diseases are the two principal risk factors for cardiovascular mortality in hemodialysis patients. Epidemiologic studies show that damage to large conduit arteries contributes to morbidity and mortality in patients with chronic kidney disease. Atherosclerosis is primarily an intimal disease characterized by the presence of plaques and occlusive lesions. Although atherosclerosis is the most frequent underlying cause of cardiovascular disease in patients with ESRD, it represents only one form of structural response to metabolic and hemodynamic alterations that interfere with the process of aging. Arterial alterations in ESRD include nonocclusive arterial remodeling accompanying the growing hemodynamic burden and humoral abnormalities that are associated with chronic uremia. The consequences of these alterations are different from those attributed to atherosclerotic plaques and are characterized principally by hardening (stiffening) of arteries. Arteriosclerosis, characterized by stiffening of the aorta and large capacitative arteries, is a major determinant of left ventricular pressure overload and of abnormal coronary perfusion. Atherosclerosis and arteriosclerosis are frequently comorbid and characterized by a high degree of both intimal and medial calcifications in patients with ESRD. The extent of calcifications and the degree of arterial stiffening are independent predictors of mortality. Studies in patients with ESRD have shown that attenuation of arterial stiffness can have a favorable effect, associated with regression of left ventricular hypertrophy, on survival. Calcium-free, metal-free phosphate binders such as sevelamer can reduce calcification scores.