Oh Jun, Wunsch Rainer, Turzer Martin, Bahner Malte, Raggi Paolo, Querfeld Uwe, Mehls Otto, Schaefer Franz
Division of Pediatric Nephrology, University Children's Hospital, Heidelberg, Germany.
Circulation. 2002 Jul 2;106(1):100-5. doi: 10.1161/01.cir.0000020222.63035.c0.
Cardiovascular mortality is excessive in young adults with end-stage renal disease (ESRD). The factors contributing to ESRD-related vascular disease are incompletely understood. Young adults with childhood-onset chronic renal failure (CRF) are uniquely suited for risk factor assessment because of their long-term exposure at an age when vascular pathology in the general population is still minimal.
We used novel noninvasive technologies to screen for coronary and carotid artery disease in 39 patients with ESRD aged 19 to 39 years with childhood-onset CRF presently treated by dialysis or renal transplantation. Coronary artery calcification burden was assessed by CT scan with ECG gating and the intima-media thickness (IMT) of the carotid arteries by high-resolution ultrasound. Coronary artery calcifications were present in 92% of patients; calcium scores exceeded the 95th age- and sex-specific percentiles >10-fold on average. Carotid IMT was significantly increased compared with matched control subjects. Both coronary calcium scores and IMT were associated with cumulative dialysis and ESRD time and the cumulative serum calcium-phosphate product. Coronary calcium scores were strongly correlated with C-reactive protein and Chlamydia pneumoniae seropositivity, time-averaged mean serum parathyroid hormone, and plasma homocysteine. C-reactive protein and parathyroid hormone independently predicted coronary calcium accumulation. Smoking, obesity, and HbA1c were correlated with IMT in the control subjects but not in the patients.
Young adults with childhood-onset CRF have a high prevalence of arteriopathy associated with indicators of microinflammation, hyperparathyroidism, calcium-phosphate overload, and hyperhomocysteinemia but not traditional atherogenic risk factors. These risk factors persist even after successful renal transplantation.
终末期肾病（ESRD）的年轻成人心血管死亡率过高。导致ESRD相关血管疾病的因素尚未完全明确。患有儿童期起病的慢性肾衰竭（CRF）的年轻成人由于在一般人群血管病变仍很轻微的年龄长期暴露，非常适合进行危险因素评估。
我们使用新型非侵入性技术对39例年龄在19至39岁、患有儿童期起病的CRF且目前接受透析或肾移植治疗的ESRD患者进行冠状动脉和颈动脉疾病筛查。通过心电图门控CT扫描评估冠状动脉钙化负荷，通过高分辨率超声评估颈动脉内膜中层厚度（IMT）。92%的患者存在冠状动脉钙化；钙评分平均超过年龄和性别特异性第95百分位数10倍以上。与匹配的对照受试者相比，颈动脉IMT显著增加。冠状动脉钙评分和IMT均与累积透析时间、ESRD时间以及血清钙磷乘积累积值相关。冠状动脉钙评分与C反应蛋白、肺炎衣原体血清阳性、时间平均血清甲状旁腺激素均值以及血浆同型半胱氨酸密切相关。C反应蛋白和甲状旁腺激素独立预测冠状动脉钙沉积。吸烟、肥胖和糖化血红蛋白在对照受试者中与IMT相关，但在患者中不相关。
患有儿童期起病的CRF的年轻成人动脉病变患病率高，与微炎症、甲状旁腺功能亢进、钙磷超载和高同型半胱氨酸血症指标相关，但与传统的动脉粥样硬化危险因素无关。即使在成功肾移植后，这些危险因素仍然存在。
