Taki K, Takayama F, Tsuruta Y, Niwa T
Department of Clinical Preventive Medicine, Nagoya University Hospital, Nagoya, Japan.
Kidney Int. 2006 Jul;70(1):218-24. doi: 10.1038/sj.ki.5000330. Epub 2006 May 24.
Coronary artery calcification is an index of the severity of atherosclerotic vascular disease, and may predict future adverse cardiovascular events in uremic patients undergoing hemodialysis (HD). HD patients are exposed to oxidative stress, and show high plasma levels of advanced glycation end products (AGEs). The association between oxidative stress, AGEs, established cardiovascular risk factors, and coronary artery calcification score (CACS) was studied in 225 HD patients (123 male, 102 female patients). CACS was measured by using multi-detector row computed tomography. Age, systolic blood pressure, calcium, calcium x phosphate, malondialdehyde, lipid peroxides, and pentosidine were significantly and positively correlated with CACS. Duration on HD tended to be positively correlated with CACS. From the independent variables included in the forward stepwise multiple linear regression analysis, only age, systolic blood pressure, lipid peroxides, calcium, and pentosidine were independently associated with CACS. The odds ratios for past history of coronary artery disease and the presence of diabetes mellitus for high CACS (> or =100) were 6.25 (95% confidence interval; 1.83-21.4) and 2.03 (95% confidence interval; 1.02-4.05), respectively. The plasma pentosidine was significantly and positively correlated with indoxyl sulfate. In conclusion, in addition to such traditional cardiovascular risk factors as past history, diabetes mellitus, aging, systolic blood pressure and calcium overload, oxidative stress (lipid peroxides), and AGE (pentosidine) are associated with extensive coronary artery calcification in HD patients. Lipid peroxidation and glycoxidation may be involved in the pathogenesis of coronary artery calcification.
冠状动脉钙化是动脉粥样硬化性血管疾病严重程度的一个指标，并且可能预测接受血液透析（HD）的尿毒症患者未来发生的不良心血管事件。HD患者暴露于氧化应激中，并且血浆中晚期糖基化终末产物（AGEs）水平较高。在225例HD患者（123例男性，102例女性患者）中研究了氧化应激、AGEs、已确定的心血管危险因素与冠状动脉钙化评分（CACS）之间的关联。使用多排探测器计算机断层扫描测量CACS。年龄、收缩压、钙、钙×磷、丙二醛、脂质过氧化物和戊糖苷与CACS显著正相关。HD治疗时间倾向于与CACS正相关。在向前逐步多元线性回归分析中纳入的自变量中，只有年龄、收缩压、脂质过氧化物、钙和戊糖苷与CACS独立相关。高CACS（≥100）的冠心病既往史和糖尿病存在的比值比分别为6.25（95%置信区间：1.83 - 21.4）和2.03（95%置信区间：1.02 - 4.05）。血浆戊糖苷与硫酸吲哚酚显著正相关。总之，除了诸如既往史、糖尿病、衰老、收缩压和钙超载等传统心血管危险因素外，氧化应激（脂质过氧化物）和AGE（戊糖苷）与HD患者广泛的冠状动脉钙化相关。脂质过氧化和糖氧化可能参与冠状动脉钙化的发病机制。
