Department of Vascular Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Muenchen, Germany.
Eur J Vasc Endovasc Surg. 2010 Jan;39(1):11-6. doi: 10.1016/j.ejvs.2009.09.024. Epub 2009 Nov 10.
Calcified plaques are suggested to represent atherosclerotic lesions with stabilising properties. However, patients with chronic kidney disease (CKD) frequently have calcified plaques but significant higher prevalence of cardiovascular complications. The aim of our study was therefore to analyse the effect of CKD in patients with advanced carotid stenosis (>70%) on plaque composition, lesion stability and risk of rupture.
We investigated retrospectively, by histology, carotid plaques of patients with high-grade internal carotid artery stenosis undergoing carotid endarterectomy. Comparison of plaque morphology was performed on 41 patients with CKD with estimated glomerular filtration rate (eGFR) <60 ml min(-1) (according to the Modification of Diet in Renal Disease formula, MDRD-eGFR) and 56 patients with normal renal function.
Patients with CKD had significantly higher percentage of total calcification (17% vs. 7%, p<0.001), unstable and ruptured plaques (83% vs. 52%, p=0.001 and 59% vs. 36%, p=0.039, respectively) compared with patients with normal renal function. By contrast, the content of collagenous fibres was significantly reduced in CKD patients (40% vs. 57%, p=0.011). No significant differences were found for neurological symptoms and soft plaque content.
Our results demonstrate that CKD significantly affects plaque composition in patients with advanced carotid artery stenosis. Enhanced calcification and reduced collagenous plaque may lead to plaque instability and rupture.
钙化斑块被认为是具有稳定特性的动脉粥样硬化病变的代表。然而，患有慢性肾脏病（CKD）的患者常伴有钙化斑块，但心血管并发症的发生率显著更高。因此，我们的研究目的是分析 CKD 对颈动脉狭窄程度较高（>70%）的患者斑块成分、病变稳定性和破裂风险的影响。
我们回顾性地通过组织学研究了接受颈动脉内膜切除术的重度颈内动脉狭窄患者的颈动脉斑块。我们比较了 41 名 CKD 患者（肾小球滤过率（eGFR）<60 ml min(-1)，根据肾脏病饮食改良公式（MDRD-eGFR））和 56 名肾功能正常的患者的斑块形态。
与肾功能正常的患者相比，CKD 患者的总钙化百分比（17% vs. 7%，p<0.001）、不稳定和破裂斑块（83% vs. 52%，p=0.001 和 59% vs. 36%，p=0.039）显著更高。相比之下，CKD 患者的胶原纤维含量明显减少（40% vs. 57%，p=0.011）。两组间神经症状和软斑块含量无显著差异。
我们的结果表明，CKD 显著影响颈动脉狭窄患者的斑块成分。增强的钙化和减少的胶原斑块可能导致斑块不稳定和破裂。
