Mesquita M, Demulder A, Wolff F, Mélot C, Damry N, Dratwa M, Bergmann P
Clinic of Nephrology, CHU Brugmann, Brussels, Belgium.
Transplant Proc. 2010 Nov;42(9):3444-9. doi: 10.1016/j.transproceed.2010.09.129.
Vascular calcifications (VCs) are important predictors of cardiovascular mortality in patients with chronic kidney disease (CKD). We have shown previously that osteoprotegerin (OPG), a potential early biomarker for VC, was an independent predictor of mortality in CKD patients. The aim of our study was to follow longitudinally coronary and aortic VCs. VCs were measured using Siemens 16 detector CT in a group of predialysis and hemodialyzed patients before and after a follow-up of 4 years. Some of these patients were transplanted in the meantime. Renal function, calcium, phosphate, iPTH, hs-CRP (high sensitive protein C reactive), and OPG serum levels were also compared. VCs progressed in predialysis, hemodialyzed, and transplanted patients but the progression was not the same in all arterial beds. A progression of coronary calcifications was observed in predialysis and transplanted patients, while aortic calcifications worsened significantly only in hemodialyzed patients. OPG serum levels and hs-CRP were significantly lower among transplanted patients. We concluded that VC depends on the severity of the kidney disease. Transplanted patients are not protected from VC, yet their OPG serum levels were significantly lower, suggesting that there is no link between between OPG levels and severity of VC. Longer follow-up of these patients would be necessary to assess whether a decline in OPG correlates with better survival.
血管钙化（VCs）是慢性肾脏病（CKD）患者心血管死亡的重要预测指标。我们之前已经表明，骨保护素（OPG）作为VC的一种潜在早期生物标志物，是CKD患者死亡率的独立预测指标。我们研究的目的是对冠状动脉和主动脉VCs进行纵向随访。在一组未透析和已透析患者中，使用西门子16层螺旋CT在随访4年前后测量VCs。在此期间，其中一些患者接受了移植。同时还比较了肾功能、钙、磷、iPTH、hs-CRP（高敏C反应蛋白）和OPG血清水平。未透析、已透析和移植患者的VCs均有进展，但在所有动脉床中的进展情况并不相同。在未透析和移植患者中观察到冠状动脉钙化有进展，而仅在已透析患者中主动脉钙化显著恶化。移植患者的OPG血清水平和hs-CRP显著较低。我们得出结论，VC取决于肾脏疾病的严重程度。移植患者并不能免受VC影响，但其OPG血清水平显著较低，这表明OPG水平与VC严重程度之间没有关联。对这些患者进行更长时间的随访，以评估OPG的下降是否与更好的生存率相关是必要的。
