成功的肾移植可降低透析患者的主动脉僵硬度并增加血管反应性。

Successful renal transplantation decreases aortic stiffness and increases vascular reactivity in dialysis patients.

作者信息

Covic A, Goldsmith D J A, Gusbeth-Tatomir P, Buhaescu I, Covic M

机构信息

C I Parhon University Hospital, Dialysis and Transplantation Center, Iasi, Romania.

出版信息

Transplantation. 2003 Dec 15;76(11):1573-7. doi: 10.1097/01.TP.0000086343.32903.A8.

DOI:10.1097/01.TP.0000086343.32903.A8

PMID:14702526

Abstract

BACKGROUND

Patients with end-stage renal disease on dialysis have among the highest cardiovascular event rates documented. Abnormal nitric oxide (NO)-dependent endothelial reactivity and increased arterial stiffness are commonly described in hemodialysis (HD) patients. Measures of aortic stiffness--aortic pulse wave velocity (PWV) and augmentation index (AGI)--have been shown to be powerful predictors of survival on hemodialysis. It is not known how these parameters interfere with successful renal transplantation.

METHODS

PWV and aortic AGI (difference between the first and second systolic peak on the aortic pressure waveform divided by the pulse wave height) were determined from contour analysis of arterial waveforms recorded by applanation tonometry using a SphygmoCor device in 41 HD patients (20 men; age, 41.8 years) and in a control group of 20 patients with essential hypertension (HTA) (10 men; age, 43.6 years). Twenty of the HD patients (10 men; age, 39.7 years) received live-related renal transplants (RTx) and were restudied (3 months after RTx, normal serum creatinine). NO-dependent and NO-independent vascular reactivity were assessed by changes in AGI after challenges with inhaled salbutamol (SAL) and sublingual nitroglycerin (NTG), respectively.

RESULTS

AGI values were significantly lower in RTx patients compared with subjects on hemodialysis (15.9 +/- 13.9% vs. 27.9 +/- 11.9%, P<0.05), but similar to essential HTA controls (16.5 +/- 17%). Serial AGI measurements showed that successful renal transplantation is associated with a decrease in AGI in all cases, from a mean of 25.1 +/- 7.8% while on dialysis to 15.9 +/- 7.0% 3 months after transplantation (P<0.0001). The responsiveness to both endothelium-dependent stimuli (inhaled SAL) and endothelium-independent stimuli (sublingual NTG) was greater in transplant patients than in hemodialysis patients (SAL-induced decrease in AGI -82.3 +/- 65.7% vs. 45 +/- 72.3%, P<0.01; and NTG-induced decrease in AGI 197 +/- 108 vs. -129.0 +/- 215.5%, P<0.01). PWV values in dialysis patients (7.19 +/- 1.88 m/sec) were significantly higher than those measured in essential HTA patients (6.34 +/- 1.32 m/sec, P<0.05) with normal renal function (despite similar blood pressure levels). PWV after RTx was 6.59 +/- 1.62 m/sec, significantly different from pretransplantation (dialysis) values (P<0.05 for comparison) but similar to the control group of essential HTA patients.

CONCLUSIONS

Renal transplantation is associated with marked improvements in vascular structure and function to a profile comparable to essential HTA patients.

摘要

背景

接受透析的终末期肾病患者具有已记录的最高心血管事件发生率。异常的一氧化氮（NO）依赖性内皮反应性和动脉僵硬度增加在血液透析（HD）患者中很常见。主动脉僵硬度的测量指标——主动脉脉搏波速度（PWV）和增强指数（AGI）——已被证明是血液透析患者生存的有力预测指标。目前尚不清楚这些参数如何影响肾移植的成功。

方法

使用SphygmoCor设备通过压平式眼压计记录的动脉波形轮廓分析，测定41例HD患者（20例男性；年龄41.8岁）和20例原发性高血压（HTA）患者对照组（10例男性；年龄43.6岁）的PWV和主动脉AGI（主动脉压力波形上第一个和第二个收缩峰之间的差值除以脉搏波高度）。20例HD患者（10例男性；年龄39.7岁）接受了活体亲属肾移植（RTx），并在移植后（血清肌酐正常3个月后）再次进行研究。分别通过吸入沙丁胺醇（SAL）和舌下含服硝酸甘油（NTG）激发后AGI的变化评估NO依赖性和非NO依赖性血管反应性。

结果

与血液透析患者相比，RTx患者的AGI值显著降低（15.9±13.9%对27.9±11.9%，P<0.05），但与原发性HTA对照组相似（16.5±17%）。连续AGI测量显示，成功的肾移植在所有情况下均与AGI降低相关，从透析时的平均25.1±7.8%降至移植后3个月的15.9±7.0%（P<0.0001）。移植患者对内皮依赖性刺激（吸入SAL）和内皮非依赖性刺激（舌下NTG）的反应性均高于血液透析患者（SAL诱导的AGI降低-82.3±65.7%对45±72.3%，P<0.01；NTG诱导的AGI降低197±108对-129.0±215.5%，P<0.01）。透析患者的PWV值（7.19±1.88米/秒）显著高于肾功能正常的原发性HTA患者（6.34±1.32米/秒，P<0.05）（尽管血压水平相似）。RTx后的PWV为6.59±1.62米/秒，与移植前（透析）值显著不同（比较P<0.05），但与原发性HTA患者对照组相似。