What factors accelerate aortic stiffening in hemodialysis patients? An observational study
What factors accelerate aortic stiffening in hemodialysis patients? An observational study
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DOI：
10.1038/hr.2009.219
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发表时间：
2010-03-01
影响因子：
5.4
通讯作者：
Saito, Takao
中科院分区：
文献类型：
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作者：
Matsumae, Tomoji;Ueda, Kazuo;Saito, Takao
主动脉硬化增加是终末期肾病（ESRD）患者心血管疾病死亡的独立预测因子。颈-股脉波速度（cfPWV）作为主动脉僵硬度的替代指标，其影响因素多种多样，但主动脉僵硬度长期恶化的决定因素仍有待阐明。为了阐明加速血液透析患者主动脉僵硬的因素，我们对148例血液透析ESRD患者进行了评估。基线时测量cfPWV和踝肱血压指数（ABPI），并评估基线时有无丙型肝炎病毒（HCV）感染、糖尿病（DM）、心脑血管疾病和外周动脉疾病的临床生化指标。随访3年后再次测量cfPWV，计算cfPWV的年变化。54例患者cfPWV下降，47例患者恶化缓慢（cfPWV年变化范围为0 ~ 0.33 m s(-1) /年），47例患者恶化迅速（cfPWV年变化大于0.33 m s(-1) /年）。糖尿病、HCV感染和外周动脉疾病的患病率在快速进展组最高。单因素分析显示，年龄、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、LDL-C/HDL-C比值、HCV感染、ABPI和血管病变数与cfPWV的年变化显著相关。逐步回归分析发现，ABPI、LDL-C/HDL-C比值和HCV感染是cfPWV恶化的独立决定因素。hcv相关增强ESRD患者主动脉僵硬的机制有待进一步研究。高血压研究（2010）33,243-249；doi: 10.1038 / hr.2009.219;2010年1月15日在线发布
Increased aortic stiffness is an independent predictor of death from cardiovascular disease in patients with end-stage renal disease (ESRD). Various factors that contribute to carotid-femoral pulse wave velocity (cfPWV) as a surrogate of aortic stiffness have been identified, but determinants of long-term worsening of aortic stiffness remain to be elucidated. To clarify the factors that accelerate aortic stiffness in hemodialysis patients, 148 patients with ESRD on hemodialysis were evaluated. At baseline, cfPWV and ankle-brachial blood pressure index (ABPI) were measured and clinical status including biochemical parameters, with or without hepatitis c virus (HCV) infection, diabetes mellitus (DM), cardiovascular disease, cerebrovascular disease and peripheral arterial disease at baseline, were evaluated. The cfPWV was measured again after a 3-year follow up and the annual change in cfPWV was calculated. The cfPWV decreased in 54 patients, worsened slowly in 47 (annual change in cfPWV ranged from 0 to 0.33 m s(-1) per year), and worsened rapidly in 47 patients (annual change in cfPWV was more than 0.33 m s(-1) per year). The prevalences of DM, HCV infection and peripheral arterial disease were the highest in the rapid progression group. Univariate analysis showed that age, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), LDL-C/HDL-C ratio, HCV infection, ABPI and number of vasculopathies were significantly associated with annual change in cfPWV. Stepwise regression analysis identified ABPI, LDL-C/HDL-C ratio and HCV infection as independent determinants of worsening of cfPWV. Further studies are needed to investigate the mechanism of HCV-related enhancement of aortic stiffness in ESRD patients. Hypertension Research (2010) 33, 243-249; doi:10.1038/hr.2009.219; published online 15 January 2010