Caro P, Delgado R, Dapena F, Núñez A
Servicio de Nefrologia, Clinica Ruber, Madrid, Spain.
Nefrologia. 2007;27(6):721-8.
Vascular calcification is a strong predictor of cardiovascular and all-cause mortality. Coronary artery calcification is more frequent, more extensive and progresses more rapidly in CKD than in general population. They are also considered a marker of coronary heart disease, with high prevalence and functional significance. It suggests that detection and surveillance may be worthwhile in general clinical practice. New non-invasive image techniques, like Multi-detector row CT, a type of spiral scanner, assess density and volume of calcification at multiple sites and allow quantitative scoring of vascular calcification using calcium scores analogous to those from electron-beam CT. We have assessed and quantified coronary artery calcification with 16 multidetector row CT in 44 patients on hemodialysis and their relationship with several cardiovascular risk factors. Coronary artery calcification prevalence was of 84 % with mean calcium score of 1580 +/- 2010 ( r 0-9844) with calcium score > 400 in 66% of patients. It was usually multiple, affecting more than two vessels in more than 50%. In all but one patient, left anterior descending artery was involved with higher calcium score level at right coronary artery. Advanced age, male, diabetes, smoking, more morbidity, cerebrovascular disease previous, and calcium-binders phosphate and analogous vitamin D treatment would seem to be associated with coronary artery calcification. Coronary artery calcification is very frequent and extensive, usually multiple and associated to modifiable risk factors in hemodialysis patients. Multi-detector-row CT seems an effective, suitable, readily applicable method to assess and quantify coronary artery calcification.
血管钙化是心血管疾病和全因死亡率的有力预测指标。与普通人群相比，冠状动脉钙化在慢性肾脏病（CKD）患者中更常见、更广泛且进展更快。它们还被视为冠心病的标志物，具有高患病率和功能意义。这表明在一般临床实践中进行检测和监测可能是值得的。新的非侵入性影像技术，如多排螺旋CT（一种螺旋扫描仪），可评估多个部位钙化的密度和体积，并能使用类似于电子束CT的钙评分对血管钙化进行定量评分。我们用16排多排螺旋CT对44例血液透析患者的冠状动脉钙化进行了评估和量化，并分析了其与多种心血管危险因素的关系。冠状动脉钙化患病率为84%，平均钙评分为1580±2010（范围0 - 9844），66%的患者钙评分>400。钙化通常为多发，超过50%的患者累及两支以上血管。除1例患者外，所有患者的左前降支均受累，右冠状动脉钙评分水平更高。高龄、男性、糖尿病、吸烟、更多的合并症、既往脑血管疾病以及使用含钙磷结合剂和类似维生素D治疗似乎与冠状动脉钙化有关。冠状动脉钙化在血液透析患者中非常常见且广泛，通常为多发，并与可改变的危险因素相关。多排螺旋CT似乎是一种有效、合适且易于应用的评估和量化冠状动脉钙化的方法。
