Volkov M M, Smirnov A V, Dobronravov V A, Degtereva O A, Sheviakova E V, Panina I Iu, Trofimenko I I
Klin Med (Mosk). 2009;87(6):31-5.
The aim of the study was to identify factors related to heart valve calcification (HVC) and effect of HVC on intracardiac hemodynamics in patients with chronic kidney disease (CKD). 377 CKD patients of the control group and 132 ones treated by hemodialysis (HD) were examined using echocardiography, cardiomonitoring, measurement of the carotid intima-media thickness and mineral bone density, X-ray imaging of calcified abdominal aorta. HVC was diagnosed in 38.9 and 27.3% of the CKD patients on hemodialysis and without it respectively. In both groups, patients with HVC were older than HVC-free ones, more of them had coronary heart disease, cardiac insufficiency, aortic calcinosis, and biochemically identifiable inflammation. In the absence of hemodialysis, patients with HVC had thicker intima-media compex, lower glomerular filtration rate, higher arterial pressure, and increased occurrence of diabetes mellitus. In HVC patients receiving hemodialysis, its duration was longer, blood PTH and calcium levels higher, forearm MOC lower. HVC associated with stenosis of mitral and aortic valves, aortic regurgitation, enlarged left and right atrium, thickened left and right ventricular wall. Multifactor analysis showed that HVC in patients receiving hemodialysis was related to the age, disbalance of phosporus and sodium, and duration of hemodialysis; in its absence, it was related to intima-media thickness and diabetes mellitus. Thus, in patients of the latter group, HVC was in the first place associated with atherosclerosis aggravated by a decrease of glomerular filtration rate and with the presence of diabetes. In patients receiving hemodialysis, HVC correlated with phosporus/sodium disbalance and atherosclerosis. The study revealed negative effect of HVC on intracardiac hemodynamics and for the first time demonstrated decreased MOC in patients with HYC.
该研究的目的是确定慢性肾脏病（CKD）患者中与心脏瓣膜钙化（HVC）相关的因素以及HVC对心内血流动力学的影响。使用超声心动图、心脏监测、测量颈动脉内膜中层厚度和矿物质骨密度、钙化腹主动脉的X线成像对377例对照组CKD患者和132例接受血液透析（HD）治疗的患者进行了检查。接受血液透析和未接受血液透析的CKD患者中HVC的诊断率分别为38.9%和27.3%。在两组中，有HVC的患者比无HVC的患者年龄更大，更多患者患有冠心病、心脏功能不全、主动脉钙化和生化可识别的炎症。在未进行血液透析的情况下，有HVC的患者内膜中层复合体更厚，肾小球滤过率更低，动脉血压更高，糖尿病发生率增加。在接受血液透析的HVC患者中，透析时间更长，血液中甲状旁腺激素和钙水平更高，前臂中分子物质（MOC）更低。HVC与二尖瓣和主动脉瓣狭窄、主动脉反流、左心房和右心房扩大、左心室壁和右心室壁增厚有关。多因素分析表明，接受血液透析的患者中HVC与年龄、磷和钠失衡以及血液透析时间有关；在未进行血液透析的情况下，则与内膜中层厚度和糖尿病有关。因此，在后一组患者中，HVC首先与肾小球滤过率降低加重的动脉粥样硬化以及糖尿病的存在有关。在接受血液透析的患者中，HVC与磷/钠失衡和动脉粥样硬化相关。该研究揭示了HVC对心内血流动力学的负面影响，并首次证明了HVC患者的MOC降低。
