Tong Li-Li, Mehrotra Rajnish, Shavelle David M, Budoff Matthew, Adler Sharon
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor, UCLA Medical Center, Torrance, California, U.S.A.
Hemodial Int. 2008 Jan;12(1):16-22. doi: 10.1111/j.1542-4758.2008.00234.x.
Vascular calcification is highly prevalent and often severe in patients with chronic kidney disease. Arterial calcification in patients with chronic kidney disease can result from the deposition of mineral along the intimal layer of arteries in conjunction with atheromatous plaques or from calcium deposition in the medial wall of arteries, also known as Monckeberg's sclerosis. Whether coronary artery calcium scores as measured by electron beam computed tomography correlate with occlusive atherosclerotic disease in the dialysis population is uncertain. Here we report a case of an asymptomatic patient with diabetes mellitus and end-stage renal disease undergoing maintenance hemodialysis, who was found to have extremely elevated coronary artery calcium scores on electron beam computed tomography, but varied degrees of atherosclerotic plaque in her coronary arteries on coronary angiography. This suggests that in addition to the calcification anticipated in a remodeled intima, a proportion of the calcification is also likely to be in the arterial media. Thus, this case demonstrates that even an extremely high coronary calcium score may not be a satisfactory surrogate marker for obstructive atherosclerosis in elderly diabetic dialysis patients.
血管钙化在慢性肾病患者中极为普遍且往往较为严重。慢性肾病患者的动脉钙化可能源于矿物质沿着动脉内膜层与动脉粥样硬化斑块一起沉积，也可能源于钙在动脉中膜壁的沉积，即所谓的蒙克贝格硬化症。通过电子束计算机断层扫描测量的冠状动脉钙化评分与透析人群中闭塞性动脉粥样硬化疾病是否相关尚不确定。在此，我们报告一例患有糖尿病和终末期肾病且正在接受维持性血液透析的无症状患者，该患者在电子束计算机断层扫描中被发现冠状动脉钙化评分极高，但在冠状动脉造影中其冠状动脉存在不同程度的动脉粥样硬化斑块。这表明，除了重塑内膜中预期的钙化外，一部分钙化也可能存在于动脉中膜。因此，该病例表明，即使冠状动脉钙化评分极高，对于老年糖尿病透析患者的阻塞性动脉粥样硬化来说，它可能也不是一个令人满意的替代标志物。
