Oyake Nobuyuki, Shimada Toshio, Murakami Yo, Ishibashi Yutaka, Satoh Hidetoshi, Suzuki Keiko, Matsumory Akira, Oda Teiji
Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan.
J Nephrol. 2008 May-Jun;21(3):345-53.
Although links have been found between microorganisms and cardiovascular diseases, the role of hepatitis C virus (HCV) infection in the pathogenesis of arteriosclerosis and cardiovascular events is unclear. The primary objective of this research was to examine whether HCV infection is associated with increased aortic stiffness and cardiovascular events in chronic hemodialysis patients.
A prospective cohort study was conducted in 94 dialysis outpatients from October 2002 to October 2004. Measurements included carotid-femoral pulse wave velocity (PWV), echocardiographic parameters, serum HCV-RNA (positive in 17 patients), and several items of biochemical data. Multiple logistic regression and the Cox proportional hazard model were used to assess independent determinants of high aortic PWV (> or =10.0 m/sec, mean) and cardiovascular events (including cerebral and peripheral vascular events), adjusting for several risk factors and duration of dialysis.
The HCV-positive group had higher aortic PWV and lower serum cholesterol levels. Multivariate analysis indicated mean blood pressure, hemoglobin A1c and HCV viremia to be independent determinants of high PWV. During the follow-up period, 13 patients suffered from cardiovascular events. Prevalence of the diseases at baseline, pulse pressure, left ventricular mass index, HCV viremia and aortic PWV were associated with cardiovascular events. The Kaplan-Meier analysis indicated a significant difference in event-free rates between HCV-positive and HCV-negative patients.
HCV infection is closely associated with increased aortic stiffness and cardiovascular event in dialysis patients.
尽管已发现微生物与心血管疾病之间存在关联，但丙型肝炎病毒（HCV）感染在动脉粥样硬化发病机制和心血管事件中的作用尚不清楚。本研究的主要目的是探讨HCV感染是否与慢性血液透析患者主动脉僵硬度增加和心血管事件有关。
2002年10月至2004年10月对94例透析门诊患者进行了一项前瞻性队列研究。测量指标包括颈股脉搏波速度（PWV）、超声心动图参数、血清HCV-RNA（17例患者呈阳性）以及多项生化数据。采用多元逻辑回归和Cox比例风险模型评估主动脉高PWV（≥10.0米/秒，平均值）和心血管事件（包括脑和外周血管事件）的独立决定因素，并对多个风险因素和透析时间进行校正。
HCV阳性组主动脉PWV较高，血清胆固醇水平较低。多变量分析表明平均血压、糖化血红蛋白A1c和HCV病毒血症是高PWV的独立决定因素。在随访期间，13例患者发生心血管事件。基线时疾病患病率、脉压、左心室质量指数、HCV病毒血症和主动脉PWV与心血管事件有关。Kaplan-Meier分析表明HCV阳性和HCV阴性患者的无事件发生率存在显著差异。
HCV感染与透析患者主动脉僵硬度增加和心血管事件密切相关。
