Nishiura Ryosuke, Kita Toshihiro, Yamada Kazuhiro, Komatsu Hiroyuki, Hara Seiichiro, Sato Yuji, Fujimoto Shouichi
Department of Internal Medicine, Circulatory and Body Fluid Regulation, Miyazaki Medical College, University of Miyazaki, Miyazaki, Japan.
Ther Apher Dial. 2008 Apr;12(2):157-63. doi: 10.1111/j.1744-9987.2008.00563.x.
Cardiovascular accidents related to atherosclerosis are the leading cause of death among hemodialysis patients, which makes continuous monitoring of their cardiovascular status crucial. Recently, a handy device for monitoring the augmentation index (AIx) in the radial artery was introduced in Japan, enabling the use of the AIx in addition to pulse wave velocity (PWV) in the management of hemodialysis patients. In this study the AIx, PWV, abdominal aortic calcification index (ACI), and left ventricular mass index (LVMI) were serially assessed in 108 hemodialysis patients. The radial AIx was monitored using a newly introduced tonometer (HEM-9010AI), and the interrelationships among the measured parameters and their contributions to the risk of cardiovascular accidents were evaluated. The radial AIx was significantly higher in hemodialysis patients than in healthy subjects (N = 50) and was well correlated with risk markers such as LVMI (r = 0.30, P = 0.019) and ACI (r = 0.38, P < 0.001), but not with PWV. Multiregression analysis showed that radial AIx was also significantly associated with LVMI, ACI and blood pressure; PWV was associated with other parameters such as age, blood pressure, and ACI. The AIx and ACI were both significantly increased in patients with cardiovascular complications. Although PWV was strongly increased in the hemodialysis patients, it failed to discriminate between these subgroups of high-risk patients. The radial AIx is closely associated with aortic calcification, cardiac hypertrophy, and a history of cardiovascular accidents in hemodialysis patients, and could be a useful marker for management of these patients.
与动脉粥样硬化相关的心血管意外是血液透析患者的主要死因，这使得持续监测他们的心血管状况至关重要。最近，日本推出了一种用于监测桡动脉增强指数（AIx）的便捷设备，使得在血液透析患者管理中除了脉搏波速度（PWV）之外还能使用AIx。在本研究中，对108例血液透析患者连续评估了AIx、PWV、腹主动脉钙化指数（ACI）和左心室质量指数（LVMI）。使用新引入的血压计（HEM - 9010AI）监测桡动脉AIx，并评估测量参数之间的相互关系及其对心血管意外风险的影响。血液透析患者的桡动脉AIx显著高于健康受试者（N = 50），并且与LVMI（r = 0.30，P = 0.019）和ACI（r = 0.38，P < 0.001）等风险标志物密切相关，但与PWV无关。多元回归分析表明，桡动脉AIx也与LVMI、ACI和血压显著相关；PWV与年龄、血压和ACI等其他参数相关。心血管并发症患者的AIx和ACI均显著升高。虽然血液透析患者的PWV大幅升高，但它无法区分这些高危患者亚组。桡动脉AIx与血液透析患者的主动脉钙化、心脏肥大和心血管意外病史密切相关，可能是管理这些患者的有用标志物。
