Aggoun Y, Niaudet P, Laffont A, Sidi D, Kachaner J, Bonnet D
Service de néphrologie pédiatrique, hôpital Necker-Enfants malades, Paris.
Arch Mal Coeur Vaiss. 2000 Aug;93(8):1009-13.
Cardiac hypertrophy and arterial dysfunction have been described in end-stage renal disease (ESDR) in adults. The incremental elastic modulus (Einc), is a marker of vascular wall material stiffness and an independant predictor of cardiovascular mortality in adults with ESRD on hemodialysis. The relationship between arterial changes and the heart is unknown in the children with ESRD in the same conditions. Using a high-resolution vascular ultrasound and a computerized system of measurement (Iotec), we assessed noninvasively 10 ESRD patients (mean +/- SD, age, 11.5 +/- 4 years; blood pressure [BP], 120 +/- 10/63 +/- 4 mmHg) and 10 age-, sex-, and BP-matched controls (mean +/- SD, age, 11 +/- 4 years; BP, 114 +/- 8/58 +/- 8 mmHg). The systolic and diastolic diameter of the common carotid artery (CCA), the thickness of the wall (intima-media thickness, IMT), the cross sectional compliance (CSC), the cross sectional distensibility (CSD) and the (Einc) were determined. CSC and CSD were evaluated at the same level of pressure. The CCA pressure waveform was obtained by applanation tonometry to assess the reflected wave by the augmentation index (AI). Further the left ventricular mass index was assessed. The flow mediated dilation (FMD) (endothelium-dependent function) and the vasodilation induced by glyceryl-trinitrate (GTNMD) (GTN, an endothelium-independent dilator) were evaluated at the brachial artery site. Compared to control subjects, ESRD patients have mechanical artery dysfunction with lower CSC and CSD (0.11 +/- 0.04 vs 0.18 +/- 0.05 mm2.mmHg-1; p < 0.01; 0.43 +/- 0.10 vs 0.82 +/- 0.20 mmHg-1.10(-2); p < 0.001) and higher Einc (2.60 +/- 1.00 vs 1.40 +/- 0.30 mmHg.10(3); p < 0.001). Furthermore an earlier return of the reflected pulse wave (AI -0.24 +/- 0.08 vs -0.58 +/- 0.06; p < 0.005) is correlated to LV mass index (r = 0.55, P < 0.01) that is significantly increased (134 +/- 63 vs 69 +/- 25 g/m2; p < 0.005). These patients have an impaired FMD (4 +/- 2 vs 7 +/- 1%; p = 0.02) with a normal GTNMD. This study shows that early arterial dysfunction can occur in children with ESRD.
成人终末期肾病（ESRD）中已出现心脏肥大和动脉功能障碍。增量弹性模量（Einc）是血管壁材料硬度的标志物，也是接受血液透析的成年ESRD患者心血管死亡率的独立预测指标。在相同情况下，儿童ESRD患者的动脉变化与心脏之间的关系尚不清楚。我们使用高分辨率血管超声和计算机测量系统（Iotec），对10例ESRD患者（平均±标准差，年龄11.5±4岁；血压[BP] 120±10/63±4 mmHg）和10例年龄、性别及血压匹配的对照者（平均±标准差，年龄11±4岁；BP 114±8/58±8 mmHg）进行了无创评估。测定了颈总动脉（CCA）的收缩和舒张直径、管壁厚度（内膜中层厚度，IMT）、横截面积顺应性（CSC）、横截面积扩张性（CSD）和（Einc）。CSC和CSD在相同压力水平下进行评估。通过压平式眼压测量法获取CCA压力波形，以通过增强指数（AI）评估反射波。此外，还评估了左心室质量指数。在肱动脉部位评估血流介导的舒张功能（FMD）（内皮依赖性功能）和硝酸甘油诱导的舒张功能（GTNMD）（GTN，一种非内皮依赖性舒张剂）。与对照者相比，ESRD患者存在机械性动脉功能障碍，CSC和CSD较低（0.11±0.04 vs 0.18±0.05 mm2·mmHg-¹；p<0.01；0.43±0.10 vs 0.82±0.20 mmHg-¹·10⁻²；p<0.001），Einc较高（2.60±1.00 vs 1.40±0.30 mmHg·10³；p<0.001）。此外，反射脉搏波的更早返回（AI -0.24±0.08 vs -0.58±0.0
