Abedi S A, Tarzamni M K, Nakhjavani M R J, Bohlooli A
Transplantation Ward, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Transplant Proc. 2009 Sep;41(7):2829-31. doi: 10.1016/j.transproceed.2009.07.037.
Vascular calcification is a strong predictor of cardiovascular and all-cause mortality. Coronary artery calcification is more frequent, more extensive, and progresses more rapidly among subjects with chronic kidney disease (CKD) than in the general population. It is also considered to be a marker of coronary heart disease, the main cause of increased morbidity and mortality among patients either on maintenance hemodialysis or after transplantation. The aim of this study was to evaluate the effect of renal transplantation on the calcium scores of coronary arteries among hemodialysis patients.
The study included 31 patients (17 males and 14 females) of age range 19 to 56 years (mean, 38.08 +/- 13.49 years) who had been hemodialyzed 3 times a week for 6 to 49 months (mean, 20 +/- 15.72 months) prior to renal transplantation. Homocysteine, intact parathyroid hormone (iPTH), calcium, phosphate, and indices of lipid metabolism such as total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides were measured before and at 6 months after transplantation. To evaluate coronary artery calcification, all patients underwent multidetector coronary computed tomography (MDCT) using the Agatston technique for calcium scoring (CS) and color Doppler ultrasound for IMT before and at 6 months after the procedure.
The prevalence of coronary artery calcifications among dialysis patients was 96% with a total CS ranging from 0 to 198. It affected more than 2 vessels in >50% of subjects with higher calcium scores in the left anterior descending artery (LAD). Mean total CS decreased significantly from pre- (39.82 +/- 63.05) to postoperation (24.34 +/- 39.55; P < .001). CS decreased from pre- to postprocedure in the left main artery (7.4 +/- 13.03 to 4.3 +/- 8.54; P < .01) and in LAD (15.76 +/- 23.53 to 10.23 +/- 15.81; P < .01 and in the circumflex (7.8 +/- 14.98 to 5.1 +/- 9.57; P < .001) and in the right coronary artery (9.2 +/- 17.18 to 4.7 +/- 8.18; P < .01). The CS before the procedure correlated significantly with age (r = .39; P < .005), P (r = .33; P < .05), Ca x P product (r = .39; P < .05), iPTH (r = .43; P < .001), and IMT (r = .56; P < .0001). There was a linear, meaningful correlation between CS and iPTH and Ca x P product reduction after renal transplantation.
Renal transplantation significantly reduced coronary artery calcification among dialysis patients. It linearly correlated with a decrease in iPTH and Ca x P product at an early period after renal transplantation.
血管钙化是心血管疾病和全因死亡率的有力预测指标。与普通人群相比，慢性肾脏病（CKD）患者的冠状动脉钙化更常见、更广泛且进展更快。它也被认为是冠心病的一个标志，而冠心病是维持性血液透析患者或移植后患者发病率和死亡率增加的主要原因。本研究的目的是评估肾移植对血液透析患者冠状动脉钙化积分的影响。
本研究纳入了31例患者（17例男性和14例女性），年龄在19至56岁之间（平均38.08±13.49岁），在肾移植前每周接受3次血液透析，持续6至49个月（平均20±15.72个月）。在移植前及移植后6个月测量同型半胱氨酸、完整甲状旁腺激素（iPTH）、钙、磷以及脂质代谢指标，如总胆固醇、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）和甘油三酯。为评估冠状动脉钙化，所有患者在手术前及术后6个月均接受了使用阿加斯顿技术进行钙化积分（CS）的多排螺旋冠状动脉计算机断层扫描（MDCT）以及用于测量内膜中层厚度（IMT）的彩色多普勒超声检查。
透析患者中冠状动脉钙化的患病率为96%，总CS范围为0至198。超过50%的受试者有超过2支血管受累，左前降支（LAD）的钙化积分更高。平均总CS从术前（39.82±63.05）显著降至术后（24.34±39.55；P<.001）。左主干动脉的CS从术前（7.4±13.03）降至术后（4.3±8.54；P<.01），LAD从术前（15.76±23.53）降至术后（10.23±15.81；P<.01），回旋支从术前（7.8±14.98）降至术后（5.1±9.57；P<.001），右冠状动脉从术前（9.2±17.18）降至术后（4.7±8.18；P<.01）。术前CS与年龄（r=.39；P<.005）、磷（r=.33；P<.05）、钙磷乘积（r=.39；P<.05）、iPTH（r=.43；P<.001）以及IMT（r=.56；P<.0001）显著相关。肾移植后CS与iPTH及钙磷乘积的降低之间存在线性、有意义的相关性。
肾移植显著降低了透析患者的冠状动脉钙化。在肾移植后的早期，它与iPTH和钙磷乘积的降低呈线性相关。
