Zoccali Carmine, Mallamaci Francesca, Parlongo Saverio, Cutrupi Sebastiano, Benedetto Francesco Antonio, Tripepi Giovanni, Bonanno Graziella, Rapisarda Francesco, Fatuzzo Pasquale, Seminara Giuseppe, Cataliotti Alessandro, Stancanelli Benedetta, Malatino Lorenzo Salvatore
CNR, Centre of Clinical Physiology and Division of Nephrology, Reggio Calabria, Italy.
Circulation. 2002 Mar 19;105(11):1354-9. doi: 10.1161/hc1102.105261.
Sympathetic tone is consistently raised in patients with end-stage renal disease (ESRD). We therefore tested the hypothesis that sympathetic activation is associated with mortality and cardiovascular events in a cohort of 228 patients undergoing chronic hemodialysis who did not have congestive heart failure at baseline and who had left ventricular ejection fraction >35%.
The plasma concentration of norepinephrine (NE) was used as a measure of sympathetic activity. Plasma NE exceeded the upper limit of the normal range (cutoff 3.54 nmol/L) in 102 dialysis patients (45%). In a multivariate Cox regression model that included all univariate predictors of death as well as the use of sympathicoplegic agents and beta-blockers, plasma NE proved to be an independent predictor of this outcome (hazard ratio [1-nmol/L increase in plasma NE]: 1.07, 95% CI 1.01 to 1.14, P=0.03). Similarly, plasma NE emerged as an independent predictor of fatal and nonfatal cardiovascular events (hazard ratio [1-nmol/L increase in plasma NE] 1.08, 95% CI 1.02 to 1.15, P=0.01) in a model that included previous cardiovascular events, pulse pressure, age, diabetes, smoking, and use of sympathicoplegic agents and beta-blockers. The adjusted relative risk for cardiovascular complications in patients with plasma NE >75th percentile was 1.92 (95% CI 1.20 to 3.07) times higher than in those below this threshold (P=0.006).
Sympathetic nerve overactivity is associated with mortality and cardiovascular outcomes in ESRD. Controlled trials with antiadrenergic drugs are needed to determine whether interference with the sympathetic system could reduce the high cardiovascular morbidity and mortality in dialysis patients.
终末期肾病（ESRD）患者的交感神经张力持续升高。因此，我们检验了以下假设：在一组228例接受慢性血液透析且基线时无充血性心力衰竭且左心室射血分数>35%的患者中，交感神经激活与死亡率和心血管事件相关。
去甲肾上腺素（NE）的血浆浓度被用作交感神经活动的指标。102例透析患者（45%）的血浆NE超过正常范围上限（临界值3.54 nmol/L）。在一个多变量Cox回归模型中，该模型纳入了所有死亡的单变量预测因素以及使用交感神经阻滞剂和β受体阻滞剂，结果显示血浆NE是这一结局的独立预测因素（风险比[血浆NE每升高1 nmol/L]：1.07，95%可信区间1.01至1.14，P=0.03）。同样，在一个纳入既往心血管事件、脉压、年龄、糖尿病、吸烟以及使用交感神经阻滞剂和β受体阻滞剂的模型中，血浆NE成为致命和非致命心血管事件的独立预测因素（风险比[血浆NE每升高1 nmol/L] 1.08，95%可信区间1.02至1.15，P=0.01）。血浆NE>第75百分位数的患者发生心血管并发症的校正相对风险比低于该阈值的患者高1.92倍（95%可信区间1.20至3.07）（P=0.006）。
ESRD患者交感神经活动过度与死亡率和心血管结局相关。需要进行抗肾上腺素能药物的对照试验，以确定干扰交感神经系统是否可降低透析患者高心血管发病率和死亡率。
