Poyrazoğlu Hakan M, Düşünsel Ruhan, Yikilmaz Ali, Narin Nazmi, Anarat Ruksan, Gündüz Zübeyde, Coşkun Abdulhakim, Baykan Ali, Oztürk Ahmet
Department of Pediatric Nephrology, Medical Faculty, Erciyes University, 38039, Kayseri, Turkey.
Pediatr Nephrol. 2007 Jan;22(1):109-16. doi: 10.1007/s00467-006-0268-2. Epub 2006 Aug 30.
Atherosclerosis is a major cause of morbidity and mortality for ESRD patients and we have little knowledge about the presence and risk factors of atherosclerosis in children with CRF. The measurement of carotid artery intima-media thickness (cIMT) using high-resolution ultrasonography is suggested as an excellent marker of subclinical atherosclerosis. In this study, we aimed to investigate the presence of atherosclerosis and to determine the relationship between atherosclerosis and some risk factors in children and young adults with ESRD. Thirty-four patients with ESRD and 20 controls were included in this study. The measurement of cIMT was performed by using a linear B-mode 7.5-MHz ultrasound transducer. We determined anemia, abnormal calcium/phosphate metabolism, hyperhomocysteinemia, hypertriglyceridemia and increased lipoprotein (a) levels in the ESRD group. The cIMT in the ESRD group was higher than in the control group (P<0.05). SBP, DBP, MAP, LVMI and LVH prevalence were statistically higher in the ESRD group (P<0.05). There were significant positive correlations between cIMT and LVMI, MBP, whereas a significant negative correlation was determined between cIMT and PTH in the ESRD group (P<0.05). When a multiple linear regression analysis was performed with cIMT as a dependent variable and LVMI, MBP, PTH, as independent variables, a significant positive correlation was determined between cIMT and LVMI (P<0.05). In conclusion, we think that arteriopathy occurs in children with ESRD. Left ventricular hypertrophy and hypertension may associate with vascular changes in children and young adults with ESRD. Further investigations are necessary to explain association of LVMI index with cIMT.
动脉粥样硬化是终末期肾病（ESRD）患者发病和死亡的主要原因，而我们对慢性肾功能衰竭（CRF）儿童动脉粥样硬化的存在情况及危险因素知之甚少。使用高分辨率超声测量颈动脉内膜中层厚度（cIMT）被认为是亚临床动脉粥样硬化的一个极佳标志物。在本研究中，我们旨在调查ESRD儿童和青年动脉粥样硬化的存在情况，并确定动脉粥样硬化与一些危险因素之间的关系。本研究纳入了34例ESRD患者和20例对照。使用线性B型7.5兆赫超声换能器进行cIMT测量。我们测定了ESRD组的贫血、钙/磷代谢异常、高同型半胱氨酸血症、高甘油三酯血症及脂蛋白（a）水平升高情况。ESRD组的cIMT高于对照组（P<0.05）。ESRD组的收缩压、舒张压、平均动脉压、左心室质量指数（LVMI）和左心室肥厚（LVH）患病率在统计学上更高（P<0.05）。ESRD组中，cIMT与LVMI、平均动脉压（MBP）之间存在显著正相关，而cIMT与甲状旁腺激素（PTH）之间存在显著负相关（P<0.05）。以cIMT作为因变量，LVMI、MBP、PTH作为自变量进行多元线性回归分析时，确定cIMT与LVMI之间存在显著正相关（P<0.05）。总之，我们认为ESRD儿童会发生动脉病变。左心室肥厚和高血压可能与ESRD儿童和青年的血管变化有关。需要进一步研究来解释LVMI指数与cIMT之间的关联。
