Raggi Paolo, Bommer Juergen, Chertow Glenn M
Division of Cardiology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
J Heart Valve Dis. 2004 Jan;13(1):134-41.
Valvular calcification is common in patients with end-stage renal disease, and is associated with an unfavorable prognosis. It was hypothesized that sevelamer, a non-calcium-based phosphorus binder, might attenuate the progression of valvular calcification.
Two hundred subjects on maintenance hemodialysis received either sevelamer or calcium-based phosphorus binders. To assess the extent of calcification, 186 subjects underwent baseline electron beam tomography (EBT) of the coronary arteries, aorta and mitral and aortic valves, and 132 had follow up EBT scans at week 52. Changes in valvular calcification and combined valvular/vascular calcification were monitored and compared.
At baseline, mitral valve calcification was seen in 46% of subjects, aortic valve calcification in 33%. Most subjects with zero values at baseline failed to progress over one year. Aortic valve calcification was significantly increased in calcium-treated subjects. Changes in mitral valve calcification, and combined mitral + aortic valve calcification were less in sevelamer-treated than in calcium-treated subjects, but not significantly so. When combining valvular and vascular calcification, the median (10%, 90%) change in sevelamer-treated subjects was significantly lower than in calcium-treated subjects (6, -5084 to 1180 versus 81, -1150 to 2944, p = 0.04). The effect of sevelamer remained significant after adjustment for baseline calcification and the time-averaged calcium-phosphorus product, and was independent of the calcium preparation (acetate versus carbonate), geographic region (US versus Europe), LDL- or HDL-cholesterol, C-reactive protein and statin use. Significantly more sevelamer-treated subjects experienced an arrest (45 versus 28%, p = 0.047) or regression (26 versus 10%, p = 0.02) in total valvular and vascular calcification.
Sevelamer arrested the progression of valvular and vascular calcification in almost 50% of hemodialysis subjects. Sevelamer treatment, plus intensive control of calcium and phosphorus levels, may attenuate progression of, or achieve regression in, cardiac valvular calcification.
瓣膜钙化在终末期肾病患者中很常见，且与不良预后相关。据推测，司维拉姆，一种非钙类磷结合剂，可能会减缓瓣膜钙化的进展。
200名维持性血液透析患者分别接受司维拉姆或钙类磷结合剂治疗。为评估钙化程度，186名受试者接受了冠状动脉、主动脉以及二尖瓣和主动脉瓣的基线电子束断层扫描（EBT），132名受试者在第52周进行了EBT随访扫描。监测并比较瓣膜钙化以及瓣膜/血管联合钙化的变化情况。
基线时，46%的受试者出现二尖瓣钙化，33%的受试者出现主动脉瓣钙化。大多数基线值为零的受试者在一年中未出现病情进展。接受钙剂治疗的受试者主动脉瓣钙化显著增加。接受司维拉姆治疗的受试者二尖瓣钙化以及二尖瓣 + 主动脉瓣联合钙化的变化小于接受钙剂治疗的受试者，但差异无统计学意义。当合并瓣膜和血管钙化时，接受司维拉姆治疗的受试者的中位数（第10百分位数，第90百分位数）变化显著低于接受钙剂治疗的受试者（6，-5084至1180对81，-1150至2944，p = 0.04）。在对基线钙化和时间平均钙磷乘积进行校正后，司维拉姆的效果仍然显著，且与钙剂制剂（醋酸盐与碳酸盐）、地理区域（美国与欧洲）、低密度脂蛋白或高密度脂蛋白胆固醇、C反应蛋白以及他汀类药物的使用无关。接受司维拉姆治疗的受试者中，总瓣膜和血管钙化出现停滞（45%对28%，p = 0.047）或逆转（26%对10%，p = 0.02）的人数显著更多。
司维拉姆使近50%的血液透析受试者的瓣膜和血管钙化进展停滞。司维拉姆治疗，加上对钙和磷水平的强化控制，可能会减缓心脏瓣膜钙化的进展或使其逆转。
