Wang Angela Yee Moon, Woo Jean, Wang Mei, Sea Mandy Man Mei, Ip Ricky, Li Philip Kam Tao, Lui Siu Fai, Sanderson John Elsby
Department of Medicine & Therapeutics, Center for Nutritional Studies, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
J Am Soc Nephrol. 2001 Sep;12(9):1927-1936. doi: 10.1681/ASN.V1291927.
Cardiac valve calcification (VC) has long been regarded as a consequence of aging and abnormal calcium-phosphate metabolism in uremic patients. In view of the recent recognition of association among inflammation, malnutrition, and atherosclerosis, the possible role of inflammation and malnutrition in VC was investigated. Inflammatory markers (including C-reactive protein [CRP], fibrinogen, and basal metabolic rate) and nutritional status (assessed using serum albumin, subjective global nutrition assessment, and handgrip strength) were examined, in addition to calcium phosphate parameters and other traditional cardiovascular risk factors, including gender, smoking habits, BP, and lipid profile, in relation to VC in 137 patients who were on continuous ambulatory peritoneal dialysis. Compared with patients with no VC, patients with VC not only were older (60 [10] versus 54 [12] yr; P = 0.005), had higher plasma phosphate (1.89 [0.52] versus 1.64 [0.41] mmol/L; P = 0.003), and had higher parathyroid hormone (83 [40, 145] versus 38 [16, 71] pmol/L; P = 0.001) but also had higher CRP (4.5 [0.1, 13.4] versus 0.2 [0.1, 4.4] mg/L; P = 0.004), had higher fibrinogen (6.6 [1.9] versus 5.7 [1.3] g/L; P = 0.002), and had lower serum albumin (26 [4] versus 29 [3] g/L; P = 0004). Twenty-three percent of patients with VC versus 17% of patients with no VC were moderately to severely malnourished according to subjective global nutrition assessment (P = 0.05). Even after adjustment for patients' age, duration of continuous ambulatory peritoneal dialysis, diabetes, and calcium x phosphate product, cardiac VC remained strongly associated with CRP (odds ratio, 1.05; P = 0.026) and albumin (odds ratio, 0.85; P = 0.01). The data suggest that VC not only is a passive degenerative process but also involves active inflammation, similar to that seen in atherosclerosis. The presence of uncontrolled hyperphosphatemia and hyperparathyroidism further accelerates the progression of calcification. The data also indicate that VC and atherosclerosis should be considered as associated syndromes, sharing similar pathogenic mechanisms, namely active inflammation.
心脏瓣膜钙化（VC）长期以来一直被视为尿毒症患者衰老及钙磷代谢异常的结果。鉴于近期认识到炎症、营养不良与动脉粥样硬化之间的关联，研究了炎症和营养不良在VC中的可能作用。除了钙磷参数以及包括性别、吸烟习惯、血压和血脂谱等其他传统心血管危险因素外，还检测了137例持续非卧床腹膜透析患者的炎症标志物（包括C反应蛋白[CRP]、纤维蛋白原和基础代谢率）和营养状况（采用血清白蛋白、主观全面营养评估和握力进行评估），以探讨其与VC的关系。与无VC的患者相比，有VC的患者不仅年龄更大（60[10]岁对54[12]岁；P = 0.005），血浆磷酸盐水平更高（1.89[0.52]对1.64[0.41]mmol/L；P = 0.003），甲状旁腺激素水平更高（83[40,145]对38[16,71]pmol/L；P = 0.001），而且CRP更高（4.5[0.1,13.4]对0.2[0.1,4.4]mg/L；P = 0.004），纤维蛋白原更高（6.6[1.9]对5.7[1.3]g/L；P = 0.002），血清白蛋白更低（26[4]对29[3]g/L；P = 0.004）。根据主观全面营养评估，有VC的患者中有23%为中度至重度营养不良，而无VC的患者中这一比例为17%（P = 0.05）。即使在对患者年龄、持续非卧床腹膜透析时间、糖尿病和钙磷乘积进行校正后，心脏VC仍与CRP（比值比，1.05；P = 0.026）和白蛋白（比值比，0.85；P = 0.01）密切相关。数据表明，VC不仅是一个被动的退行性过程，还涉及类似于动脉粥样硬化中所见的主动炎症。未控制的高磷血症和甲状旁腺功能亢进的存在进一步加速了钙化的进展。数据还表明，VC和动脉粥样硬化应被视为相关综合征，具有相似的致病机制，即主动炎症。
