Cardiovascular Imaging and Clinical Research Core Laboratory and Cardiovascular Division, Washington University School of Medicine, St. Louis, Mo., USA.
Am J Nephrol. 2011;33(2):131-8. doi: 10.1159/000323550. Epub 2011 Jan 17.
Vascular calcification is a major contributor to morbidity and mortality in hemodialysis. The objective of this pilot study was to determine the feasibility, safety and efficacy of sodium thiosulfate (STS) in the progression of vascular calcification in hemodialysis patients.
Chronic hemodialysis patients underwent a battery of cardiovascular tests. Those with coronary artery calcium (Agatston scores >50) received intravenous STS after each dialysis for 5 months (n = 22) and the tests were repeated. Changes in MDCT-determined calcification were assessed as the mean annualized rate of change in 3 vascular beds (coronary, thoracic and carotid arteries) and in L1-L2 vertebral bone density.
Although individual analyses showed coronary artery calcification progression in 14/22 subjects, there was no progression in the mean annualized rate of change of vascular calcification in the entire group. The L1-L2 vertebral bone density showed no changes. There were no correlations between rates of progression of vascular calcification and phosphorus, fetuin or C-reactive protein levels. Changes in coronary artery calcification scores correlated with those of the thoracic aorta.
STS treatment is feasible, appears safe and may decrease the rate of progression of vascular calcification in hemodialysis patients. A large, randomized, controlled trial is warranted.
血管钙化是血液透析患者发病率和死亡率的主要原因。本研究旨在确定硫代硫酸钠（STS）在血液透析患者血管钙化进展中的可行性、安全性和疗效。
慢性血液透析患者接受了一系列心血管测试。那些有冠状动脉钙化（Agatston 评分>50）的患者在每次透析后接受静脉内 STS 治疗 5 个月（n=22），并重复测试。通过 MDCT 评估 3 个血管床（冠状动脉、胸主动脉和颈动脉）和 L1-L2 椎体骨密度的钙化变化，评估平均每年钙化变化率。
尽管个别分析显示 14/22 名患者的冠状动脉钙化进展，但整个组的血管钙化平均每年变化率没有进展。L1-L2 椎体骨密度没有变化。血管钙化进展率与磷、胎球蛋白或 C 反应蛋白水平之间没有相关性。冠状动脉钙化评分的变化与胸主动脉的变化相关。
STS 治疗是可行的，似乎是安全的，可以降低血液透析患者血管钙化进展的速度。需要进行大规模、随机、对照试验。
