McCullough Peter A, Agarwal Mohit, Agrawal Varun
Department of Medicine, Division of Cardiology, William Beaumont Hospital, 4949 Coolidge, Royal Oak, MI 48073, USA.
Nephrology (Carlton). 2009 Jun;14(4):428-36. doi: 10.1111/j.1440-1797.2009.01138.x.
Atherosclerosis, once present, in the intimal and medial spaces of the blood vessel wall becomes calcified due to a variety of cellular and metabolic processes. Patients with chronic kidney disease (CKD) appear to have both accelerated and amplified vascular calcification compared with the general population. Calcium deposition within vascular tissue in the form of calcium hydroxyapatite crystals appears to be a permanent step in the mature atherosclerotic plaque, and to date has not been found to be reversible or modifiable with common treatments for atherosclerosis or dialysis management strategies. Densely calcified lesions with a circumferential arc of calcium around the vessel wall may be severely stenotic, however, are unlikely to develop symptomatic plaque rupture with an acute coronary syndrome. For that reason, the expected outcomes of atherosclerotic therapies in patients with CKD bone and mineral disorder have not followed the same rules of evidence. This paper will review the differences between the CKD and general population with respect to vascular calcification and the observed natural history in observational and interventional studies.
动脉粥样硬化一旦出现，血管壁内膜和中膜间隙会因各种细胞和代谢过程而发生钙化。与普通人群相比，慢性肾脏病（CKD）患者似乎存在血管钙化加速和加重的情况。以羟基磷灰石晶体形式存在于血管组织内的钙沉积似乎是成熟动脉粥样硬化斑块中的一个永久性步骤，迄今为止，尚未发现其可通过常见的动脉粥样硬化治疗方法或透析管理策略逆转或改变。血管壁周围有一圈致密钙化病变且呈圆周状的病变可能会严重狭窄，但不太可能因急性冠状动脉综合征而出现有症状的斑块破裂。因此，CKD骨与矿物质紊乱患者动脉粥样硬化治疗的预期结果并不遵循相同的证据规则。本文将综述CKD患者与普通人群在血管钙化方面的差异，以及观察性和干预性研究中观察到的自然病程。
