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腹膜透析人群中的冠状动脉钙化、全身炎症标志物与矿物质代谢

Coronary artery calcification, systemic inflammation markers and mineral metabolism in a peritoneal dialysis population.

作者信息

Ammirati Adriano Luiz, Dalboni Maria Aparecida, Cendoroglo Miguel, Draibe Sérgio Antonio, Fernandes Canziani Maria Eugênia

机构信息

Nephrology Division, Federal University of São Paulo, São Paulo, Brazil.

出版信息

Nephron Clin Pract. 2006;104(1):c33-40. doi: 10.1159/000093257. Epub 2006 May 9.

Abstract

AIMS

To assess the prevalence of coronary artery calcification (CAC) in peritoneal dialysis (PD) patients and to determine whether comorbidities such as inflammation, dyslipidemia and mineral metabolism disorders correlate with its development.

METHODS

Forty-nine PD patients (45% male; median age, 52 years) were submitted to multislice computed tomography. Inflammatory markers, anti-oxidized LDL antibody, calcium-phosphate balance and lipid profiles were assessed.

RESULTS

Twenty-nine patients (59.2%) presented CAC (median calcium score, 234.7 Agatston units). Patients with CAC were older than those without, more frequently presented a history of coronary artery disease or hypertension and had lower HDL cholesterol levels, as well as presenting higher levels of osteoprotegerin and LDL oxidation. The logistic regression revealed that the independent determinants of CAC were age (odds ratio = 1.12; p = 0.006) and number of prescribed anti-hypertensive drugs (odds ratio = 2.38; p = 0.048). When the population was stratified by calcium score quartile, soluble Fas levels were significantly higher in patients with severe calcification. In patients younger than 45, CAC correlated positively with phosphorus levels (r = 0.52; p = 0.04).

CONCLUSION

In PD patients, CAC is highly prevalent. Our results indicate that conditions such as inflammation and mineral disturbances are associated with its development.

摘要

目的

评估腹膜透析(PD)患者冠状动脉钙化(CAC)的患病率,并确定炎症、血脂异常和矿物质代谢紊乱等合并症是否与其发生相关。

方法

49例PD患者(男性占45%;中位年龄52岁)接受多层计算机断层扫描。评估炎症标志物、抗氧化低密度脂蛋白抗体、钙磷平衡和血脂谱。

结果

29例患者(59.2%)出现CAC(中位钙评分234.7阿加斯顿单位)。有CAC的患者比没有的患者年龄更大,更频繁地有冠状动脉疾病或高血压病史,高密度脂蛋白胆固醇水平更低,同时骨保护素和低密度脂蛋白氧化水平更高。逻辑回归显示,CAC的独立决定因素是年龄(比值比=1.12;p=0.006)和抗高血压药物的处方数量(比值比=2.38;p=0.048)。当按钙评分四分位数对人群进行分层时,严重钙化患者的可溶性Fas水平显著更高。在45岁以下的患者中,CAC与磷水平呈正相关(r=0.52;p=0.04)。

结论

在PD患者中,CAC非常普遍。我们的结果表明,炎症和矿物质紊乱等情况与其发生有关。

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