Shroff Rukshana C, Donald Ann E, Hiorns Melanie P, Watson Alan, Feather Sally, Milford David, Ellins Elizabeth A, Storry Clare, Ridout Deborah, Deanfield John, Rees Lesley
Department of Nephrourology, Great Ormond Street Hospital and Institute of Child Health, London, United Kingdom.
J Am Soc Nephrol. 2007 Nov;18(11):2996-3003. doi: 10.1681/ASN.2006121397. Epub 2007 Oct 17.
Cardiovascular disease is increasingly recognized as a life-limiting problem in young patients with chronic kidney disease, but there are few studies in children that describe its determinants. We studied the association of intact parathyroid hormone (iPTH) levels and their management on vascular structure and function in 85 children, ages 5-18 years, who had received dialysis for > or =6 months. Compared to controls, dialysis patients had increased carotid intima-media thickness and pulse-wave velocity. All vascular measures positively correlated with serum phosphorus levels, while carotid intima-media thickness and cardiac calcification score also correlated with iPTH levels. Patients with mean time-integrated iPTH levels less than twice the upper limit of normal (n = 41) had vascular measures that were comparable to age-matched controls, but those with iPTH levels greater than twice the upper limit of normal (n = 44) had greater carotid intima-media thickness, stiffer vessels, and increased cardiac calcification than controls. Patients with increased carotid intima-media thickness had stiffer vessels and a greater prevalence of cardiac calcification. There was a strong dose-dependent correlation between vitamin D and all vascular measures, and calcium intake from phosphate binders weakly correlated with carotid intima-media thickness. In conclusion, both iPTH level and dosage of vitamin D are associated with vascular damage and calcification in children on dialysis.
心血管疾病日益被认为是慢性肾病年轻患者的一个限制生命的问题，但针对儿童心血管疾病决定因素的研究较少。我们研究了85名年龄在5至18岁、接受透析≥6个月的儿童中，完整甲状旁腺激素（iPTH）水平及其管理与血管结构和功能之间的关联。与对照组相比，透析患者的颈动脉内膜中层厚度和脉搏波速度增加。所有血管测量指标均与血清磷水平呈正相关，而颈动脉内膜中层厚度和心脏钙化评分也与iPTH水平相关。平均时间积分iPTH水平低于正常上限两倍的患者（n = 41），其血管测量指标与年龄匹配的对照组相当，但iPTH水平高于正常上限两倍的患者（n = 44），其颈动脉内膜中层厚度更大、血管更僵硬，且心脏钙化比对照组增加。颈动脉内膜中层厚度增加的患者血管更僵硬，心脏钙化的患病率更高。维生素D与所有血管测量指标之间存在强烈的剂量依赖性相关性，而来自磷结合剂的钙摄入量与颈动脉内膜中层厚度呈弱相关。总之，iPTH水平和维生素D剂量均与透析儿童的血管损伤和钙化有关。
