Mitsnefes Mark M, Kimball Thomas R, Kartal Janis, Witt Sandra A, Glascock Betty J, Khoury Philip R, Daniels Stephen R
Division of Nephrology and Hypertension, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA.
J Am Soc Nephrol. 2005 Sep;16(9):2796-803. doi: 10.1681/ASN.2005030291. Epub 2005 Jul 27.
In children, cardiac abnormalities such as increased left ventricular mass (LVM) and diastolic dysfunction develop at the time of mild to moderate chronic renal insufficiency (CRI) and progress as renal function deteriorates. It was hypothesized that in this age group, vascular abnormalities develop early in the course of chronic kidney disease (CKD) in parallel with cardiac abnormalities and become more severe as end-stage disease is reached. Echocardiography and ultrasound of the carotid artery were performed on 44 patients with CKD stages 2 to 4 (CRI group), 16 patients who were on maintenance dialysis, and 35 healthy individuals. Carotid artery intima-media thickness (cIMT) was measured and distensibility and stiffness were calculated to assess carotid artery structure and function. Both the CRI and dialysis groups had greater cIMT, higher LVM index, and poorer diastolic function than the control subjects (P < 0.0001). Children who were on dialysis had greater cIMT and higher LVM index than those with CRI (P < 0.001) and greater arterial stiffness than both CRI patients and control subjects (P < 0.001). Arterial compliance was similar in CRI and control subjects. In all patients with CKD (CRI and dialysis), increased calcium-phosphorus product predicted increased cIMT. Increased serum phosphorus and intact parathyroid hormone predicted increased arterial stiffness. Elevated intact parathyroid hormone was a predictor of increased LVM index and poor diastolic function. In dialysis patients, the cumulative dose of phosphate binders and calcitriol predicted abnormal vascular structure and function. It is concluded that vascular abnormalities are already present in children and adolescents during early stages of CKD; they are more severe in children who are on maintenance dialysis and are related to abnormal calcium-phosphorus metabolism.
在儿童中，诸如左心室质量（LVM）增加和舒张功能障碍等心脏异常在轻度至中度慢性肾功能不全（CRI）时出现，并随着肾功能恶化而进展。据推测，在这个年龄组中，血管异常在慢性肾脏病（CKD）病程早期与心脏异常同时出现，并在达到终末期疾病时变得更加严重。对44例CKD 2至4期患者（CRI组）、16例维持性透析患者和35名健康个体进行了超声心动图和颈动脉超声检查。测量颈动脉内膜中层厚度（cIMT），并计算扩张性和僵硬度以评估颈动脉结构和功能。CRI组和透析组的cIMT均大于对照组，左心室质量指数更高，舒张功能更差（P<0.0001）。透析患儿的cIMT大于CRI患儿，左心室质量指数更高（P<0.001），动脉僵硬度大于CRI患者和对照组（P<0.001）。CRI组和对照组的动脉顺应性相似。在所有CKD患者（CRI组和透析组）中，钙磷乘积升高预示着cIMT增加。血清磷和完整甲状旁腺激素升高预示着动脉僵硬度增加。完整甲状旁腺激素升高是左心室质量指数增加和舒张功能不良的预测指标。在透析患者中，磷结合剂和骨化三醇的累积剂量预示着血管结构和功能异常。结论是，血管异常在CKD儿童和青少年的早期阶段就已存在；在维持性透析儿童中更为严重，并且与钙磷代谢异常有关。
