Hermans Marc M H, Brandenburg Vincent, Ketteler Markus, Kooman Jeroen P, van der Sande Frank M, Gladziwa Ulrich, Rensma Pieter L, Bartelet Karlijn, Konings Constantijn J A M, Hoeks Arnold P G, Floege Jürgen, Leunissen Karel M L
Department of Internal Medicine and Nephrology, Academic Hospital Maastricht, PO box 5800, 6202 AZ, Maastricht, The Netherlands.
Nephrol Dial Transplant. 2006 May;21(5):1293-9. doi: 10.1093/ndt/gfk045. Epub 2006 Jan 5.
An increase in aortic stiffness, as reflected by an increase in pulse wave velocity (PWV) or aortic augmentation index (AI) is an important predictor of cardiovascular mortality in dialysis patients. Dysregulation of calcification inhibitors, such as fetuin-A, is involved in vascular pathology in dialysis patients and fetuin-A is inversely related to mortality in dialysis patients. In this study, the relation between serum fetuin-A concentration and parameters of aortic stiffness was investigated in patients with end-stage renal disease.
In a cross-sectional study we included 131 dialysis patients, aged 62+/-14 years (33 on peritoneal dialysis and 98 on haemodialysis), and 41 controls, aged 60+/-8 years. Time-averaged pre-dialysis values of serum albumin, Ca, P and intact parathyroid hormone were included in multiregression analysis, as were high-sensitivity C-reactive protein (hsCRP), fetuin-A, age, mean arterial pressure (MAP) and dialysis modality. PWV and AI were measured with the SphygmoCor device.
Mean fetuin-A concentration in dialysis patients (0.63+/-0.16 g/l) did not differ from controls (0.63+/-0.11 g/l). Median hsCRP levels in dialysis patients were higher compared with controls (4.0 vs 1.9 mg/l; P<0.0001). PWV but not AI was higher in dialysis patients than in controls (9.9 vs 7.9 m/s; P<0.0001). In univariate analysis in dialysis patients, fetuin-A levels were inversely related to both PWV (r = - 0.25, P = 0.007) and AI (r = - 0.26, P = 0.006), respectively. However, after correction for age, gender, MAP and diabetes mellitus, this relation lost statistical significance.
In a dialysis population with a relatively low level of inflammatory activity, the soluble calcification inhibitor fetuin-A could not be identified as an independent predictor of aortic stiffness as measured with PWV and AI.
脉搏波速度（PWV）或主动脉增强指数（AI）升高所反映的主动脉僵硬度增加是透析患者心血管死亡的重要预测指标。钙化抑制剂（如胎球蛋白-A）的失调与透析患者的血管病变有关，且胎球蛋白-A与透析患者的死亡率呈负相关。在本研究中，我们调查了终末期肾病患者血清胎球蛋白-A浓度与主动脉僵硬度参数之间的关系。
在一项横断面研究中，我们纳入了131例透析患者，年龄为62±14岁（33例接受腹膜透析，98例接受血液透析），以及41例对照者，年龄为60±8岁。血清白蛋白、钙、磷和完整甲状旁腺激素的透析前时间平均水平纳入多因素回归分析，高敏C反应蛋白（hsCRP）、胎球蛋白-A、年龄、平均动脉压（MAP）和透析方式也纳入分析。使用SphygmoCor设备测量PWV和AI。
透析患者的平均胎球蛋白-A浓度（0.63±0.16 g/l）与对照者（0.63±0.11 g/l）无差异。透析患者的hsCRP中位数水平高于对照者（4.0 vs 1.9 mg/l；P<0.0001）。透析患者的PWV高于对照者，但AI无差异（9.9 vs 7.9 m/s；P<0.0001）。在透析患者的单因素分析中，胎球蛋白-A水平分别与PWV（r = - 0.25，P = 0.007）和AI（r = - 0.26，P = 0.006）呈负相关。然而，在校正年龄、性别、MAP和糖尿病后，这种关系失去统计学意义。
在炎症活动水平相对较低的透析人群中，可溶性钙化抑制剂胎球蛋白-A不能被确定为用PWV和AI测量的主动脉僵硬度的独立预测指标。
