Preston Emma, Ellis Mary R, Kulinskaya Elena, Davies Alun H, Brown Edwina A
Renal Medicine, Faculty of Medicine, Imperial College London, Charing Cross Hospital, London, UK.
Am J Kidney Dis. 2005 Nov;46(5):856-62. doi: 10.1053/j.ajkd.2005.07.048.
Common carotid artery intima-media thickness (CCA-IMT) correlates with cardiovascular events in the general population and is an independent predictor of cardiovascular mortality in the hemodialysis population. It has not been evaluated extensively in patients with chronic kidney disease.
CCA-IMT was measured by using high-resolution B-mode ultrasonography, and glomerular filtration rate (GFR) was measured by means of EDTA clearance. Cardiovascular risk factors assessed included homocysteine and lipoprotein(a) levels, as well as smoking, blood pressure, and cholesterol level.
One hundred fourteen patients were studied; mean measured GFR was 29.6 +/- 18.4 mL/min/1.73 m2 (0.49 +/- 0.31 mL/s). CCA-IMT was significantly elevated (0.59 +/- 0.22 cm) compared with a control group (0.44 +/- 0.08 cm; P = 0.0012). CCA-IMT increases with age (P < 0.0001) and low-density lipoprotein level (P = 0.048) and decreases with high-density lipoprotein level (P = 0.001) and being white (P = 0.014).
This study suggests that arterial changes occur early in the course of renal disease progression and may be related to dyslipidemia in the early stages.
在普通人群中,颈总动脉内膜中层厚度(CCA-IMT)与心血管事件相关,并且是血液透析人群心血管死亡率的独立预测指标。在慢性肾脏病患者中尚未对此进行广泛评估。
采用高分辨率B型超声测量CCA-IMT,通过乙二胺四乙酸清除率测量肾小球滤过率(GFR)。评估的心血管危险因素包括同型半胱氨酸和脂蛋白(a)水平,以及吸烟、血压和胆固醇水平。
对114例患者进行了研究;测得的平均GFR为29.6±18.4 mL/min/1.73 m2(0.49±0.31 mL/s)。与对照组(0.44±0.08 cm;P = 0.0012)相比,CCA-IMT显著升高(0.59±0.22 cm)。CCA-IMT随年龄增长(P < 0.0001)和低密度脂蛋白水平升高(P = 0.048)而增加,随高密度脂蛋白水平升高(P = 0.001)和白人种族(P = 0.014)而降低。
本研究提示,在肾脏疾病进展过程中动脉改变出现较早,且可能与疾病早期的血脂异常有关。