Oflaz Huseyin, Pusuroglu Hamdi, Genchallac Hakan, Demirel Seref, Bugra Zehra, Sever Mehmet S, Yildiz Alaattin
Department of Cardiology, Division of Nephrology, Istanbul School of Medicine, Istanbul, Turkey.
Clin Transplant. 2003 Dec;17(6):528-33. doi: 10.1046/j.1399-0012.2003.00100.x.
Endothelial dysfunction (ED) is a common precursor and denominator of cardiovascular events including development of atherosclerosis. In this cross-sectional, controlled study, we aimed to investigate ED measured by ischemia-induced forearm vasodilatation in chronic hemodialysis (HD) patients and renal transplant recipients (rTX).
Thirty-nine HD patients, 39 rTX and 38 normotensive healthy controls were included. There was no difference in age and gender distribution among the study groups. The mean time spent on dialysis and transplantation were 74 +/- 46 and 68 +/- 39 months. Serum high sensitive C-reactive protein (hs-CRP) and plasma fibrinogen levels were measured. Endothelium dependent post-ischemic vasodilatation of brachial artery was used to evaluate ED.
The hs-CRP and plasma fibrinogen levels were significantly increased in HD patients when compared with rTX. On high resolution ultrasonographic examination, post-ischemic vasodilatation values in HD patients (9.55 +/- 6.47%) were significantly lower than rTX (14.39 +/- 8.06%, p = 0.007) and controls (20.42 +/- 6.10%, p < 0.001). Renal transplant recipients also had significantly lower post-ischemic vasodilatation values than controls (p = 0.001). The hs-CRP levels were negatively correlated with endothelium-dependent dilatations in TX (r = -0.59, p = 0.001), however, this correlation was not detected in HDp.
Patients with end-stage renal disease have ED. Endothelial function is more impaired in HD patients than rTX. Different mechanisms might be responsible for ED in HD patients and rTX.
内皮功能障碍（ED）是包括动脉粥样硬化发展在内的心血管事件的常见先兆和共同特征。在这项横断面对照研究中，我们旨在研究慢性血液透析（HD）患者和肾移植受者（rTX）中通过缺血诱导的前臂血管舒张测量的内皮功能障碍。
纳入39例HD患者、39例rTX患者和38例血压正常的健康对照者。各研究组间年龄和性别分布无差异。透析和移植的平均时间分别为74±46个月和68±39个月。检测血清高敏C反应蛋白（hs-CRP）和血浆纤维蛋白原水平。采用肱动脉缺血后血管舒张来评估内皮功能障碍。
与rTX患者相比，HD患者的hs-CRP和血浆纤维蛋白原水平显著升高。在高分辨率超声检查中，HD患者的缺血后血管舒张值（9.55±6.47%）显著低于rTX患者（14.39±8.06%，p = 0.007）和对照组（20.42±6.10%，p < 0.001）。肾移植受者的缺血后血管舒张值也显著低于对照组（p = 0.001）。hs-CRP水平与TX患者的内皮依赖性扩张呈负相关（r = -0.59，p = 0.001），然而，在HD患者中未检测到这种相关性。
终末期肾病患者存在内皮功能障碍。HD患者的内皮功能比rTX患者受损更严重。HD患者和rTX患者内皮功能障碍可能由不同机制引起。
