Ziolkowska Helena, Brzewski Michal, Roszkowska-Blaim Maria
Department of Pediatrics and Nephrology, Medical University of Warsaw, Marszałkowska 24, Warsaw, Poland.
Pediatr Nephrol. 2008 May;23(5):805-11. doi: 10.1007/s00467-007-0733-6. Epub 2008 Jan 29.
The aim of the study was to evaluate changes in the arterial wall in children with chronic kidney disease (CKD). We studied 60 patients: 32 with stages 2-4 CKD [chronic renal failure (CRF)], 28 with stage 5 CKD [end-stage renal disease (ESRD)], and 43 controls (C). The evaluated parameters included intima-media thickness (IMT) of the carotid arteries, bone mineral density (BMD), serum lipid levels, and parameters of the calcium-phosphorus metabolism. Patients were divided into two groups: group 1 with normal arteries, and group 2 with arterial changes. The highest serum fetuin A level was found in group 1 compared with groups 2 and C. A negative correlation between IMT and fetuin A level was found. In patients with ESRD, a positive correlation of IMT with phosphorus level and age and a negative correlation with cyclase-activating parathyroid hormone and cyclase inhibiting parathyroid hormone (CAP/CIP) ratio was observed. Multiple linear regression showed that lower fetuin-A and alkaline phosphatase (AP) levels and higher lumbar spine BMD independently predicted higher IMT. Arterial wall changes in children with CKD were related to lower fetuin A and AP level and higher BMD. Low CAP/CIP and high phosphorus level may also be significant factors for arterial changes in patients with ESRD.
本研究的目的是评估慢性肾脏病（CKD）患儿动脉壁的变化。我们研究了60例患者：32例2-4期CKD[慢性肾衰竭（CRF）]患者，28例5期CKD[终末期肾病（ESRD）]患者，以及43例对照（C）。评估参数包括颈动脉内膜中层厚度（IMT）、骨密度（BMD）、血脂水平以及钙磷代谢参数。患者被分为两组：1组动脉正常，2组有动脉变化。与2组和C组相比，1组血清胎球蛋白A水平最高。发现IMT与胎球蛋白A水平呈负相关。在ESRD患者中，观察到IMT与磷水平和年龄呈正相关，与环化酶激活甲状旁腺激素和环化酶抑制甲状旁腺激素（CAP/CIP）比值呈负相关。多元线性回归显示，较低的胎球蛋白A和碱性磷酸酶（AP）水平以及较高的腰椎BMD独立预测较高的IMT。CKD患儿的动脉壁变化与较低的胎球蛋白A和AP水平以及较高的BMD有关。低CAP/CIP和高磷水平也可能是ESRD患者动脉变化的重要因素。
