Civilibal Mahmut, Caliskan Salim, Oflaz Huseyin, Sever Lale, Candan Cengiz, Canpolat Nur, Kasapcopur Ozgur, Bugra Zehra, Arisoy Nil
Department of Pediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty, 34303 Cerrahpasa, Istanbul, Turkey.
Pediatr Nephrol. 2007 Jul;22(7):1021-9. doi: 10.1007/s00467-007-0451-0. Epub 2007 Mar 6.
Cardiovascular disease (CVD) is the principal cause of mortality in patients with end-stage renal disease (ESRD). The aim of this study was to analyze carotid intima-media thickness (cIMT), endothelium-dependent dilatation (EDD), and left ventricular mass index (LVMI) as the cardiovascular risk markers and to investigate the independent risk factors of these markers in pediatric dialysis patients. This study included 39 children and adolescents undergoing dialysis (15 hemodialysis and 24 peritoneal dialysis) and 15 age- and gender-matched healthy subjects. The cIMT and EDD were assessed by high-resolution ultrasound, and LVMI was calculated from standard echocardiographic measurements. Compared with control subjects, cIMT standard deviation scores (SDS), LVMI, total homocysteine (tHcy), and high-sensitivity C-reactive protein (hs-CRP) values were significantly higher in patients, but EDD values did not differ. The mean hs-CRP level was significantly higher in hemodialysis (HD) patients than in peritoneal dialysis (PD) patients. The cIMT-SDS and LVMI were associated with several variables in univariate analysis. Stepwise linear regression analysis, indexed SBP (p = 0.017), and hemoglobin (p = 0.001) turned out to be independent variables for predicting LVMI, and a significant predictor of cIMT was indexed diastolic blood pressure (DBP) (p = 0.035). The causes of atherosclerosis and left ventricular hypertrophy are multifactorial in children and adolescents with ESRD. Better management of hypertension and anemia may be priorities for preventing or improving CVD in these patients.
心血管疾病（CVD）是终末期肾病（ESRD）患者死亡的主要原因。本研究的目的是分析颈动脉内膜中层厚度（cIMT）、内皮依赖性舒张功能（EDD）和左心室质量指数（LVMI）作为心血管风险标志物，并调查这些标志物在儿科透析患者中的独立危险因素。本研究纳入了39例接受透析的儿童和青少年（15例血液透析和24例腹膜透析）以及15例年龄和性别匹配的健康受试者。通过高分辨率超声评估cIMT和EDD，并根据标准超声心动图测量计算LVMI。与对照组相比，患者的cIMT标准差评分（SDS）、LVMI、总同型半胱氨酸（tHcy）和高敏C反应蛋白（hs-CRP）值显著更高，但EDD值无差异。血液透析（HD）患者的平均hs-CRP水平显著高于腹膜透析（PD）患者。在单因素分析中，cIMT-SDS和LVMI与多个变量相关。逐步线性回归分析显示，指数化收缩压（SBP）（p = 0.017）和血红蛋白（p = 0.001）是预测LVMI的独立变量，而指数化舒张压（DBP）（p = 0.035）是cIMT的显著预测因子。在患有ESRD的儿童和青少年中，动脉粥样硬化和左心室肥厚的原因是多因素的。更好地控制高血压和贫血可能是预防或改善这些患者CVD的首要任务。
