Wang Angela Yee-Moon, Ho Stella Sin-Yee, Liu Eric Kin-Hung, Chan Iris Hiu-Shuen, Ho Simon, Sanderson John E, Lam Christopher Wai-Kei
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR, China.
Am J Nephrol. 2007;27(5):458-65. doi: 10.1159/000106457. Epub 2007 Jul 26.
This study sought to examine the associations of traditional and non-traditional cardiovascular risk factors with carotid intima-media thickening and plaque in peritoneal dialysis (PD) patients.
A cross-sectional study was performed in 147 PD patients with carotid intima-media thickness (IMT) and plaque assessed by B-mode ultrasonography and fasting blood collected for biochemical measurements.
On univariate analysis, age, smoking history, fibrinogen, C-reactive protein (CRP), adiponectin, fetuin-A, lipoprotein(a) and diastolic blood pressure were associated with carotid IMT while age, smoking history, diabetes, CRP and diastolic blood pressure were associated with carotid plaque. Using multivariate analysis, elevated CRP (p = 0.015) and serum calcium (p = 0.022) were associated with carotid plaque but not with IMT. CRP and serum calcium were synergistically associated with carotid plaque in that those with CRP > median and serum calcium > median showed the highest prevalence of carotid plaque than either factor alone (p = 0.003).
An elevated CRP appeared to be a better biomarker of presence of carotid plaque than intima-media thickening. Furthermore, CRP and serum calcium showed synergistic association with presence of carotid plaque. However, our study was limited by the cross-sectional design and baseline laboratory abnormalities were inevitably confounded by the treatment already given, resulting in difficulty to distinguish cause and effect relationship. Nevertheless, these observations warrant further investigation as it may potentially have important implications on differentiating therapeutic strategies for reducing carotid IMT and plaque progression in PD patients.
本研究旨在探讨传统和非传统心血管危险因素与腹膜透析（PD）患者颈动脉内膜中层增厚及斑块的相关性。
对147例PD患者进行了一项横断面研究，通过B型超声评估颈动脉内膜中层厚度（IMT）和斑块，并采集空腹血进行生化检测。
单因素分析显示，年龄、吸烟史、纤维蛋白原、C反应蛋白（CRP）、脂联素、胎球蛋白-A、脂蛋白（a）和舒张压与颈动脉IMT相关，而年龄、吸烟史、糖尿病、CRP和舒张压与颈动脉斑块相关。多因素分析显示，CRP升高（p = 0.015）和血清钙升高（p = 0.022）与颈动脉斑块相关，但与IMT无关。CRP和血清钙与颈动脉斑块存在协同关联，即CRP>中位数且血清钙>中位数的患者颈动脉斑块患病率高于单一因素（p = 0.003）。
CRP升高似乎比内膜中层增厚更能作为颈动脉斑块存在的生物标志物。此外，CRP和血清钙与颈动脉斑块的存在显示出协同关联。然而，我们的研究受横断面设计的限制，基线实验室异常不可避免地受到已接受治疗的混淆，导致难以区分因果关系。尽管如此，这些观察结果值得进一步研究，因为它可能对区分PD患者减少颈动脉IMT和斑块进展的治疗策略具有重要意义。
