Tsuchihashi K, Takizawa H, Torii T, Ikeda R, Nakahara N, Yuda S, Kobayashi N, Nakata T, Ura N, Shimamoto K
2nd Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
Nephron. 2000 Jan;84(1):13-20. doi: 10.1159/000045533.
BACKGROUND/AIM: Progressive cardiovascular calcification in dialysis patients with end-stage renal disease (ESRD) is a serious complication; however, the precise mechanism remains uncertain. We tested whether metabolic calcium abnormalities and hypoparathyroidism might have a correlation with cardiovascular complications in ESRD patients.
A series of 48 ESRD patients with cardiovascular diseases and/or congestive heart failure, aged 36-82 (61 +/- 12) years, 23 male and 25 female, were enrolled in this study. Serum total calcium (Ca, mmol/l), inorganic phosphate (mmol/l), and intact parathyroid hormone (iPTH, pg/ml) levels were determined in all cases.
Organic heart disease was confirmed in 28 patients (58.3%), including 15 with coronary artery disease: 8 with aortic aneurysm, 8 with stenotic valvular heart disease, 9 with excessive mitral annular calcification, 3 with dialysis cardiomyopathy, and 7 with obstructive arterial disease. Serum iPTH measurement revealed hypoparathyroidism (iPTH <60) in 20 of 48 (41.7%) and hyperthyroidism (iPTH >/=200) in 13 of 48 (27.1%) subjects. The 20 patients with low iPTH had a higher prevalence of valvular heart disease, a higher total Ca level corrected for serum albumin (2.70 +/- 0.30 in low iPTH vs. 2.47 +/- 0.30 in normal iPTH, 2.35 +/- 0.20 in high iPTH, p = 0.003) and a higher tendency of vitamin D(3) analog use (65% in low iPTH vs. 33% in normal iPTH and 46% in high iPTH, p = 0.078). Moreover, corrected serum Ca exhibited a negative logarithmic correlation with serum iPTH: corrected Ca = -0.284x log (iPTH) + 3.021 (r = 0.637, p = 0.0001). Multiple logistic regression analysis revealed diabetes and hypoparathyroidism (iPTH <60) as risk factors for cardiovascular complications in ESRD.
These results suggest that hypercalcemia and hypoparathyroidism in conjunction with vitamin D(3) use might play an important role in cardiovascular complications of chronic dialysis patients.
背景/目的：终末期肾病（ESRD）透析患者中进行性心血管钙化是一种严重并发症；然而，确切机制仍不确定。我们测试了代谢性钙异常和甲状旁腺功能减退是否可能与ESRD患者的心血管并发症相关。
本研究纳入了48例患有心血管疾病和/或充血性心力衰竭的ESRD患者，年龄36 - 82（61±12）岁，男性23例，女性25例。测定所有患者的血清总钙（Ca，mmol/L）、无机磷（mmol/L）和完整甲状旁腺激素（iPTH，pg/ml）水平。
28例患者（58.3%）确诊患有器质性心脏病，其中15例患有冠状动脉疾病；8例患有主动脉瘤；8例患有瓣膜狭窄性心脏病；9例有二尖瓣环钙化过度；3例患有透析性心肌病；7例患有阻塞性动脉疾病。血清iPTH检测显示，48例患者中有20例（41.7%）甲状旁腺功能减退（iPTH <60），48例中有13例（27.1%）甲状旁腺功能亢进（iPTH≥200）。20例iPTH水平低的患者瓣膜性心脏病患病率更高，校正血清白蛋白后的总钙水平更高（低iPTH组为2.70±0.30，正常iPTH组为2.47±0.30，高iPTH组为2.35±0.20，p = 0.003），使用维生素D3类似物的倾向更高（低iPTH组为65%，正常iPTH组为33%，高iPTH组为46%，p = 0.078）。此外，校正后的血清钙与血清iPTH呈负对数相关：校正钙 = -0.284×log（iPTH）+ 3.021（r = 0.637，p = 0.0001）。多因素逻辑回归分析显示，糖尿病和甲状旁腺功能减退（iPTH <60）是ESRD患者心血管并发症的危险因素。
这些结果表明，高钙血症、甲状旁腺功能减退以及维生素D3的使用可能在慢性透析患者的心血管并发症中起重要作用。
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