Delucchi A, Dinamarca H, Gainza H, Whitttle C, Torrealba I, Iñiguez G
Pediatric and Transplant Departments, Luis Calvo Mackenna Children's Hospital, University of Chile, Santiago, Chile.
Transplant Proc. 2008 Nov;40(9):3244-6. doi: 10.1016/j.transproceed.2008.03.126. Epub 2008 Jun 30.
Cardiovascular diseases are the principal cause of morbidity and mortality among young adults with chronic renal disease. Atherosclerotic structural changes as detected by high-resolution B-mode ultrasonography preceed clinical findings by several decades. The carotid intima-media thickness (cIMT) is being used as a marker of early atherosclerosis. We determined the cIMT of common carotid artery (CCA) in 8 asymptomatic children on dialysis or 12 after renal transplantation for comparison with 30 healthy controls. This prospective study of 40 children showed a mean age of 13.5 years (range, 8 to 18). We evaluated cIMT, hemoglobin, serum creatinine levels, lipid profile, and homeostasis model assessment (HOMA). The statistical analysis for variables with normal distribution was Student's t test. Parameters with a non-normal distribution were evaluated by the Mann-Whitney or Spearman correlation analysis with P < .05 considered statistically significant. The mean measurements of cIMT (mm) of both CCA were dialysis 0.450 +/- 0.042; transplant 0.467 +/- 0.033, and controls 0.380 +/- 0.009 (P < .03). The homa levels of 2.45 +/- 0.98 for dialysis and 1.8 +/- 0.62 for transplant, were both significantly higher than the control group (0.8 +/- 0.09; P < .01). The Ca x P product was higher in dialysis vs transplant group: 63.0 +/- 10.0 versus 46.2 +/- 2.2 (P < .03). The intact parathyroid hormone levels were 666.7 +/- 276.7 versus 44.2 +/- 2.8, respectively (P < .008). The low-density lipoprotein cholesterol was 129.0 +/- 23.1 versus 80.8 +/- 10.6, respectively (P < .04). The cIMT correlated with the duration of dialysis before transplantation. Changes in IMT can be detected by ultrasonography in early childhood in uremic patients. The etiology of atherosclerosis is multifactorial in children with end-stage renal disease. It seems possible to prevent or improve the factors related to cardiovascular risk in these patients.
心血管疾病是慢性肾病青年患者发病和死亡的主要原因。高分辨率B型超声检测到的动脉粥样硬化结构变化比临床发现早几十年。颈动脉内膜中层厚度（cIMT）被用作早期动脉粥样硬化的标志物。我们测定了8名无症状透析儿童和12名肾移植后儿童的颈总动脉（CCA）的cIMT，与30名健康对照进行比较。这项对40名儿童的前瞻性研究显示平均年龄为13.5岁（范围8至18岁）。我们评估了cIMT、血红蛋白、血清肌酐水平、血脂谱和稳态模型评估（HOMA）。对正态分布变量的统计分析采用学生t检验。对非正态分布参数采用Mann-Whitney或Spearman相关分析，P <.05被认为具有统计学意义。双侧CCA的cIMT（mm）平均测量值为：透析组0.450±0.042；移植组0.467±0.033，对照组0.380±0.009（P <.03）。透析组的HOMA水平为2.45±0.98，移植组为1.8±0.62，均显著高于对照组（0.8±0.09；P <.01）。透析组的钙磷乘积高于移植组：63.0±10.0比46.2±2.2（P <.03）。完整甲状旁腺激素水平分别为666.7±276.7和44.2±2.8（P <.008）。低密度脂蛋白胆固醇分别为129.0±23.1和80.8±10.6（P <.04）。cIMT与移植前透析时间相关。超声检查可在幼儿期检测到尿毒症患者IMT的变化。终末期肾病儿童动脉粥样硬化的病因是多因素的。在这些患者中预防或改善与心血管风险相关的因素似乎是可能的。
