未接受透析的慢性肾功能衰竭患者的冠状动脉钙化

Coronary artery calcification in patients with CRF not undergoing dialysis.

作者信息

Russo Domenico, Palmiero Giuseppe, De Blasio Antonietta P, Balletta Mario M, Andreucci Vittorio E

机构信息

Department of Nephrology, University Federico II, Naples, Italy.

出版信息

Am J Kidney Dis. 2004 Dec;44(6):1024-30. doi: 10.1053/j.ajkd.2004.07.022.

DOI:10.1053/j.ajkd.2004.07.022

PMID:15558523

Abstract

BACKGROUND

Coronary artery calcification (CAC) correlates with the extent of coronary atherosclerosis and, consequently, with an increased risk for cardiovascular events. CAC is more frequent in uremic patients than in the general population. Nearly all data about CAC relate to patients on dialysis therapy. This study evaluates the prevalence and extent of CAC in patients with chronic renal failure (CRF) not yet on dialysis therapy.

METHODS

Consecutive outpatients with CRF not on dialysis therapy were enrolled and compared with controls (ie, healthy volunteers and patients with essential hypertension with normal renal function). Patients and controls were asymptomatic and had no previous history of myocardial infarction, coronary bypass surgery, or angioplasty. Patients with diabetes were excluded. Clinical characteristics, biochemical test results (included homocysteinemia and C-reactive protein level), and serum concentrations of calcium, phosphorus, and intact parathyroid hormone (iPTH) were evaluated in patients and controls. CACs were searched for and scored by means of spiral computed tomography (CT). To assess the CAC progression rate, spiral CT was repeated in some patients.

RESULTS

Eighty-five patients and 55 controls were studied. Patients were aged 52 +/- 13 years and had a CRF duration of 6.3 +/- 5.6 years, glomerular filtration rate of 33.0 +/- 16.0 mL/min (0.55 +/- 0.27 mL/s), serum calcium level of 9.5 +/- 0.5 mg/dL (2.37 +/- 0.12 mmol/L), serum phosphorus level of 4.1 +/- 0.9 mg/dL (1.32 +/- 0.29 mmol/L), and serum iPTH level of 143 +/- 121 pg/mL (ng/L). CAC was found in 40% of patients and 13% of controls; calcification scores were 422 +/- 634 in patients and 43.9 +/- 33 in controls. Only age ( P < 0.001) was a predictor of CAC. In patients with a repeated score performed (after a mean of 7.9 months), calcification scores increased (from 383 +/- 627 to 682 +/- 890) in 8 of 10 patients.

CONCLUSION

CAC is already present in the early phase of CRF; the prevalence is greater in patients with CRF than in controls, but less than that reported in dialysis patients. Serum concentrations of calcium, phosphorus, iPTH, and inflammation markers do not predict the appearance or progression of CAC.

摘要

背景

冠状动脉钙化（CAC）与冠状动脉粥样硬化程度相关，因此也与心血管事件风险增加相关。尿毒症患者的CAC比普通人群更常见。几乎所有关于CAC的数据都与接受透析治疗的患者有关。本研究评估尚未接受透析治疗的慢性肾衰竭（CRF）患者中CAC的患病率和程度。

方法

纳入连续的未接受透析治疗的CRF门诊患者，并与对照组（即健康志愿者和肾功能正常的原发性高血压患者）进行比较。患者和对照组均无症状，且既往无心肌梗死、冠状动脉搭桥手术或血管成形术病史。排除糖尿病患者。评估患者和对照组的临床特征、生化检测结果（包括高同型半胱氨酸血症和C反应蛋白水平）以及钙、磷和完整甲状旁腺激素（iPTH）的血清浓度。通过螺旋计算机断层扫描（CT）查找并评估CAC。为评估CAC进展率，对部分患者重复进行螺旋CT检查。

结果

共研究了85例患者和55例对照。患者年龄为52±13岁，CRF病程为6.3±5.6年，肾小球滤过率为33.0±16.0 mL/min（0.55±0.27 mL/s），血清钙水平为9.5±0.5 mg/dL（2.37±0.12 mmol/L），血清磷水平为4.1±0.9 mg/dL（1.32±0.29 mmol/L），血清iPTH水平为143±121 pg/mL（ng/L）。40%的患者和13%的对照发现有CAC；患者的钙化评分为422±634，对照为43.9±33。只有年龄（P<0.001）是CAC的预测因素。在重复评分的患者中（平均7.9个月后），10例患者中有8例钙化评分增加（从383±627增至682±890）。