Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
J Atheroscler Thromb. 2010 Feb 26;17(2):165-72. doi: 10.5551/jat.2097. Epub 2010 Feb 3.
Cerebrovascular disease (CVD) is a major determinant of the prognosis in end-stage renal diseases (ESRD). The purpose of this study was to examine whether factors associated with arterial stiffness contributed to the development of CVD in patients with ESRD.
CVD (lacunes and carotid/intracranial artery stenosis) was evaluated with brain magnetic resonance imaging (MRI), and carotid/intracranial artery magnetic resonance angiography (MRA) in 44 pre-dialytic patients. The severity of CVD was evaluated by the number of lacunes and the degree of stenosis, respectively. The association between CVD and atherosclerotic parameters was evaluated.
Patients with severe lacunes (n=18) manifested older age, lower diastolic blood pressure, serum creatinine and albumin, and higher CRP and serum calcium than those with absent-moderate lacunes (n=26). When assessed by multivariate analysis, only baPWV was adopted as an independent risk factor for severe lacunes. Furthermore, baPWV and i-PTH were associated with the severity of carotid/intracranial artery stenosis, both of which were independent of other risk factors, including age and diabetes.
Arterial stiffness may constitute a novel determinant predicting the severity of CVD in pre-dialytic patients besides classical risk factors.
脑血管疾病（CVD）是终末期肾病（ESRD）患者预后的主要决定因素。本研究旨在探讨与动脉僵硬度相关的因素是否有助于 ESRD 患者 CVD 的发生。
通过脑磁共振成像（MRI）和颈动脉/颅内动脉磁共振血管造影（MRA）评估 44 例透析前患者的 CVD（腔隙和颈动脉/颅内动脉狭窄）。分别通过腔隙数量和狭窄程度评估 CVD 的严重程度。评估 CVD 与动脉粥样硬化参数之间的关系。
严重腔隙组（n=18）患者的年龄较大、舒张压较低、血清肌酐和白蛋白较低、CRP 和血清钙较高，与无/中度腔隙组（n=26）相比。多因素分析显示，只有臂踝脉搏波速度（baPWV）是严重腔隙的独立危险因素。此外，baPWV 和 i-PTH 与颈动脉/颅内动脉狭窄的严重程度相关，均独立于年龄和糖尿病等其他危险因素。
除了传统的危险因素外，动脉僵硬度可能是预测透析前患者 CVD 严重程度的一个新的决定因素。
