Department of Internal Medicine, Section of Nephrology, Fatih University School of Medicine, Gokkusagi Mahallesi 16. Cadde, No + 16/21, Cevizlidere/Cankaya, Ankara, Turkey.
Int Urol Nephrol. 2010 Sep;42(3):741-52. doi: 10.1007/s11255-009-9675-1. Epub 2009 Nov 19.
Patients with end-stage renal disease treated by chronic dialysis have an impressive mortality, which more than half of this mortality is attributable to cardiovascular disease. Despite stratification for sex, race, and the presence of diabetes, cardiovascular disease mortality is 10-30 times higher in dialysis patients compared to general population. In dialysis patients, both atherosclerosis (mainly affecting the intima of the arteries) and arteriosclerosis (affecting predominantly the media of large- and middle-sized arteries diffusely) are highly prominent. Arteriosclerosis characterized by reduced arterial compliance (i.e., reduced elasticity of the arteries) is due to increased fibrosis, loss of elastic fibers, and extensive vessel wall calcification. Arteriosclerosis is closely related to arterial stiffness. A generally accepted mechanistic view is that an increase in arterial stiffness causes a premature return of reflected waves in late systole, increasing central pulse pressure, thus systolic. An increased arterial stiffness can increase the risk of stroke through several mechanisms, including an increase in central pulse pressure, influencing arterial remodeling both at the site of the extracranial and intracranial arteries, increasing carotid wall thickness, and the development of stenosis and plaques, and the likelihood of plaque rupture. Very importantly, it was also suggested that arterial stiffness itself independently plays a role in exacerbating chronic kidney disease progression. This review deals briefly with the definition of arterial stiffness, methods of measuring arterial stiffness and pathophysiology of arterial stiffness, and factors related with arterial stiffness.
接受慢性透析治疗的终末期肾病患者死亡率惊人，其中超过一半的死亡归因于心血管疾病。尽管根据性别、种族和糖尿病的存在进行了分层，但与普通人群相比，透析患者的心血管疾病死亡率高出 10-30 倍。在透析患者中，动脉粥样硬化（主要影响动脉内膜）和动脉硬化（主要影响大中动脉的中膜弥漫性）都非常突出。动脉顺应性降低（即动脉弹性降低）的动脉硬化是由于纤维化增加、弹性纤维丧失和广泛的血管壁钙化所致。动脉硬化与动脉僵硬度密切相关。一个被普遍接受的机制观点是，动脉僵硬度的增加导致反射波在收缩晚期过早返回，增加中心脉搏压，从而增加收缩压。动脉僵硬度增加可通过多种机制增加中风风险，包括增加中心脉搏压、影响颅外和颅内动脉部位的动脉重塑、增加颈动脉壁厚度以及狭窄和斑块的发展，以及斑块破裂的可能性。非常重要的是，还有研究表明动脉僵硬度本身独立地在加重慢性肾脏病进展方面发挥作用。这篇综述简要介绍了动脉僵硬度的定义、动脉僵硬度的测量方法和病理生理学，以及与动脉僵硬度相关的因素。
