Dellegrottaglie Santo, Saran Rajiv, Rajagopalan Sanjay
Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.
Cardiol Clin. 2005 Aug;23(3):373-84. doi: 10.1016/j.ccl.2005.04.001.
The mortality from cardiovascular events in CKD and dialysis patients is substantially higher than in the general population. VC is ubiquitous and progresses rapidly in this patient population. Although there has been progress in the understanding of the pathogenesis and correlates of VC, much work needs to be done in this area. The role of calcium and, probably, phosphate (obligatory participants) is unquestionable, but the understanding of the paracrine and molecular determinants of VC in renal failure is continuously evolving. VC is probably a dynamic process resulting from the imbalance between molecules that promote and those that inhibit VC. The understanding of latter area has recently evolved with identification of new signaling pathways with molecules such as osteoprotegerin, fetuin-A, and MPG. From a clinical perspective, new modalities such as EBCT and MDCT allow noninvasive detection and quantification of VC. VC may represent a potential useful index for prognostic stratification and treatment planning in patients who have renal failure. At present, however, the data on the prognostic value of VC are available only in populations of patients who have normal renal function. Large-scale, prospective, observational studies should be designed to identify the determinants of VC and to define the prognostic role of calcium scoring in cohorts of patients who have predialysis CKD and with ESRD.
慢性肾脏病（CKD）和透析患者心血管事件的死亡率显著高于普通人群。血管钙化（VC）在这一患者群体中普遍存在且进展迅速。尽管在理解VC的发病机制及其相关因素方面已取得进展，但该领域仍有许多工作要做。钙以及可能还有磷（必要参与者）的作用是毋庸置疑的，但对肾衰竭中VC的旁分泌和分子决定因素的理解仍在不断发展。VC可能是一个动态过程，由促进和抑制VC的分子之间的失衡导致。随着骨保护素、胎球蛋白-A和MPG等分子新信号通路的发现，对后一领域的理解最近有了进展。从临床角度来看，电子束计算机断层扫描（EBCT）和多层螺旋计算机断层扫描（MDCT）等新方法可实现VC的无创检测和量化。VC可能是肾衰竭患者预后分层和治疗规划的一个潜在有用指标。然而，目前关于VC预后价值的数据仅来自肾功能正常的患者群体。应设计大规模、前瞻性观察性研究以确定VC的决定因素，并明确在透析前CKD和终末期肾病（ESRD）患者队列中钙评分的预后作用。
