Turkmen Kultigin, Oflaz Huseyin, Uslu Bora, Cimen Arif O, Elitok Ali, Kasikcioglu Erdem, Alisir Sabahat, Tufan Fatih, Namli Sule, Uysal Mukremin, Ecder Tevfik
Department of Internal Medicine, Istanbul School of Medicine, Istanbul, Turkey.
Clin J Am Soc Nephrol. 2008 Jul;3(4):986-91. doi: 10.2215/CJN.02330607. Epub 2008 Mar 19.
Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal dominant polycystic kidney disease. Endothelial dysfunction, an early and reversible feature in the pathogenesis of atherosclerosis, is associated with increased vascular smooth muscle tone, arterial stiffening, and increased intima-media thickness. Coronary flow velocity reserve is a noninvasive test showing endothelial function of epicardial coronary arteries and coronary microcirculatory function. The aim of the study was to investigate the carotid intima-media thickness and coronary flow velocity reserve in patients with autosomal dominant polycystic kidney disease.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Thirty normotensive patients with autosomal dominant polycystic kidney disease (10 male, 20 female) with well-preserved renal function and 30 healthy subjects (12 male, 18 female) were included in the study. Coronary flow velocity reserve was measured at baseline and after dipyridamole infusion by echocardiography. Coronary flow velocity reserve was calculated as the ratio of hyperemic to baseline diastolic peak velocities.
Carotid intima-media thickness was significantly higher in patients than in control subjects (0.80 +/- 0.29 versus 0.54 +/- 0.14 mm, respectively; P < 0.001). Moreover, coronary flow velocity reserve was significantly lower in patients than in control subjects (1.84 +/- 0.39 versus 2.65 +/- 0.68, respectively; P < 0.001).
Normotensive patients with autosomal dominant polycystic kidney disease with well-preserved renal function have significantly increased carotid intima-media thickness and significantly decreased coronary flow velocity reserve compared with healthy subjects. These findings suggest that atherosclerosis starts at an early stage in the course of their disease in patients with autosomal dominant polycystic kidney disease.
心血管问题是常染色体显性多囊肾病患者发病和死亡的主要原因。内皮功能障碍是动脉粥样硬化发病机制中的一个早期且可逆的特征，与血管平滑肌张力增加、动脉僵硬和内膜中层厚度增加有关。冠状动脉血流储备是一项无创检查，可显示心外膜冠状动脉的内皮功能和冠状动脉微循环功能。本研究的目的是调查常染色体显性多囊肾病患者的颈动脉内膜中层厚度和冠状动脉血流储备。
设计、地点、参与者及测量方法：本研究纳入了30例肾功能良好的血压正常的常染色体显性多囊肾病患者（男性10例，女性20例）和30例健康受试者（男性12例，女性18例）。通过超声心动图在基线时和双嘧达莫输注后测量冠状动脉血流储备。冠状动脉血流储备通过充血期与基线舒张期峰值速度之比来计算。
患者的颈动脉内膜中层厚度显著高于对照组（分别为0.80±0.29与0.54±0.14mm；P<0.001）。此外，患者的冠状动脉血流储备显著低于对照组（分别为1.84±0.39与2.65±0.68；P<0.001）。
与健康受试者相比，肾功能良好的血压正常的常染色体显性多囊肾病患者的颈动脉内膜中层厚度显著增加，冠状动脉血流储备显著降低。这些发现表明，常染色体显性多囊肾病患者在疾病过程中早期就开始出现动脉粥样硬化。
