Haydar Ali A, Hujairi Nabil M A, Covic Adrian A, Pereira Divaka, Rubens Michael, Goldsmith David J A
Renal and Teansplantation Unit, Guy's Hospital, London SE1 9RT, UK.
Nephrol Dial Transplant. 2004 Sep;19(9):2307-12. doi: 10.1093/ndt/gfh120. Epub 2004 Jun 22.
Coronary artery calcification (CAC) measured by electron beam computed tomography (EBCT) correlates with plaque burden, vessel stenosis and is predictive of future cardiac events in the general population. Extensive CAC has been described recently in dialysis cohorts. For the first time we studied the relationship between CAC and coronary angiographic findings in patients with chronic renal failure, on dialysis and after renal transplantation.
We studied 46 patients who all had an EBCT-derived Agatston coronary calcium score and a diagnostic coronary angiogram within a 12-month period. The mean age was 55.7+/-13.2 (SD) years (range 29-80). The mean duration of dialysis was 54.4 months (range 1-372).
The mean CAC was 2370+/-352.8. The mean CAC in patients with an abnormal coronary angiogram (n = 35) was 2869.6+/-417.9, while that in patients with a normal coronary angiogram (n = 11) was 559.4+/-255.1 (P = 0.001 for the inter-mean comparison). Total CAC correlated with the number of diseased vessels (P = 0.0001) and with severity of atherosclerosis in all the vessels (P = 0.0001). The individual coronary artery calcification score correlated well with the severity of atherosclerotic coronary disease (P<0.0001 for all) in the left anterior descending, right coronary and circumflex arteries. Running a multivariate regression analysis for atherosclerosis burden, we found that the only predictor was CAC (r = 0.34, P = 0.0001).
CAC is common and more severe in patients with chronic kidney disease. Although in chronic kidney disease patients CAC can occur in the absence of occlusive coronary atherosclerosis, our data suggest that, as in the general population, CAC in chronic kidney disease patients is associated with obstructive atherosclerosis and may therefore be associated with a worse outcome.
通过电子束计算机断层扫描（EBCT）测量的冠状动脉钙化（CAC）与斑块负荷、血管狭窄相关，并且可预测普通人群未来的心脏事件。最近在透析人群中发现了广泛的CAC。我们首次研究了慢性肾衰竭患者、透析患者及肾移植后患者的CAC与冠状动脉造影结果之间的关系。
我们研究了46例患者，这些患者在12个月内均进行了基于EBCT的阿加斯顿冠状动脉钙化评分及诊断性冠状动脉造影。平均年龄为55.7±13.2（标准差）岁（范围29 - 80岁）。平均透析时间为54.4个月（范围1 - 372个月）。
平均CAC为2370±352.8。冠状动脉造影异常患者（n = 35）的平均CAC为2869.6±417.9，而冠状动脉造影正常患者（n = 11）的平均CAC为559.4±255.1（均值间比较P = 0.001）。总CAC与病变血管数量相关（P = 0.0001），并与所有血管的动脉粥样硬化严重程度相关（P = 0.0001）。个体冠状动脉钙化评分与左前降支、右冠状动脉和回旋支动脉的动脉粥样硬化性冠状动脉疾病严重程度密切相关（所有P<0.0001）。对动脉粥样硬化负荷进行多因素回归分析时，我们发现唯一的预测因素是CAC（r = 0.34，P = 0.0001）。
CAC在慢性肾脏病患者中很常见且更严重。虽然在慢性肾脏病患者中，CAC可在无闭塞性冠状动脉粥样硬化的情况下出现，但我们的数据表明，与普通人群一样，慢性肾脏病患者的CAC与阻塞性动脉粥样硬化相关，因此可能与更差的预后相关。
