Guérin Alain P, Pannier Bruno, Marchais Sylvain J, London Gérard M
Hôpital Manhès, 8 rue Roger Clavier, Fleury-Mérogis, 91712, France.
Curr Hypertens Rep. 2008 Apr;10(2):107-11. doi: 10.1007/s11906-008-0021-2.
Cardiovascular disease is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Macrovascular disease develops rapidly in ESRD patients and is responsible for the high incidence of left ventricular hypertrophy, ischemic heart disease, cerebrovascular accidents, and peripheral artery diseases. Occlusive lesions due to atheromatous plaques frequently cause these complications; however, atherosclerosis represents only one form of structural response to metabolic and hemodynamic alterations interfering with the "natural" process of aging. The spectrum of arterial alterations in ESRD is broader, including large artery remodeling, changes in viscoelastic properties, and stiffening of arterial walls. Nonatheromatous remodeling principally changes the dampening function of arteries, characterized by stiffening of arterial walls and with deleterious effects on the left ventricle and coronary perfusion. The origin of arterial stiffening in ESRD patients is multifactorial, with extensive arterial calcifications as an important covariate.
心血管疾病是终末期肾病（ESRD）患者发病和死亡的主要原因。大血管疾病在ESRD患者中发展迅速，是导致左心室肥厚、缺血性心脏病、脑血管意外和外周动脉疾病高发的原因。动脉粥样硬化斑块引起的闭塞性病变常导致这些并发症；然而，动脉粥样硬化只是对干扰“自然”衰老过程的代谢和血流动力学改变的一种结构反应形式。ESRD患者的动脉改变范围更广，包括大动脉重塑、粘弹性特性改变和动脉壁僵硬。非动脉粥样硬化性重塑主要改变动脉的缓冲功能，其特征是动脉壁僵硬，对左心室和冠状动脉灌注产生有害影响。ESRD患者动脉僵硬的起源是多因素的，广泛的动脉钙化是一个重要的协变量。
