常染色体显性多囊肾病患者的外周增强指数与血管炎症。
Peripheral augmentation index and vascular inflammation in autosomal dominant polycystic kidney disease.
机构信息
Department of Epidemiology and Public Health, National University of Singapore.
出版信息
Nephrol Dial Transplant. 2011 Aug;26(8):2515-21. doi: 10.1093/ndt/gfq806. Epub 2011 Feb 3.
BACKGROUND
Cardiovascular disease is the leading cause of premature mortality in autosomal dominant polycystic kidney disease (ADPKD). We examined peripheral augmentation index (AIx) as a measure of systemic vascular function and circulating markers of vascular inflammation in patients with ADPKD.
METHODS
Fifty-two ADPKD patients with hypertension and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2), 50 ADPKD patients with hypertension and eGFR ≥ 60 mL/min/1.73 m(2), 42 normotensive ADPKD patients with eGFR ≥ 60 mL/min/1.73 m(2) and 51 normotensive healthy controls were enrolled in this study. AIx was measured from peripheral artery tone recordings using finger plethysmography. Serum levels of soluble intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule-1, P-selectin, E-selectin, soluble Fas (sFas) and Fas ligand (FasL) were measured as markers of vascular inflammation.
RESULTS
AIx was higher in all three patient groups with ADPKD compared to healthy controls (P < 0.05). AIx was similar between the normotensive ADPKD patients with eGFR ≥ 60 mL/min/1.73 m(2) and hypertensive ADPKD patients with eGFR < 60 mL/min/1.73 m(2) (P > 0.05). ICAM, P-selectin, E-selectin and sFas were higher and FasL lower in all ADPKD groups compared to controls (P < 0.05). ICAM, P-selectin and E-selectin were similar between the normotensive ADPKD patients with eGFR ≥ 60 mL/min/1.73 m(2) and hypertensive ADPKD patients with eGFR < 60 mL/min/1.73 m(2) (P > 0.05). According to multiple regression analysis, predictors of AIx in ADPKD included age, height, heart rate and mean arterial pressure (P < 0.05). Vascular inflammatory markers were not predictors of AIx in ADPKD.
CONCLUSIONS
Systemic vascular dysfunction, manifesting as an increase in AIx and vascular inflammation is evident in young normotensive ADPKD patients with preserved renal function. Vascular inflammation is not associated with elevated AIx in ADPKD.
背景
心血管疾病是常染色体显性多囊肾病（ADPKD）患者过早死亡的主要原因。我们研究了外周动脉增强指数（AIx）作为全身血管功能的指标，并检测了 ADPKD 患者的血管炎症循环标志物。
方法
52 例患有高血压且肾小球滤过率（eGFR）<60 mL/min/1.73 m2 的 ADPKD 患者，50 例患有高血压且 eGFR≥60 mL/min/1.73 m2 的 ADPKD 患者，42 例血压正常且 eGFR≥60 mL/min/1.73 m2 的 ADPKD 患者和 51 例血压正常的健康对照者被纳入本研究。通过手指容积描记法从外周动脉张力记录中测量 AIx。血清可溶性细胞间黏附分子（ICAM）-1、血管细胞黏附分子-1、P 选择素、E 选择素、可溶性 Fas（sFas）和 Fas 配体（FasL）水平作为血管炎症的标志物进行测量。
结果
与健康对照组相比，所有三组 ADPKD 患者的 AIx 均较高（P<0.05）。血压正常且 eGFR≥60 mL/min/1.73 m2 的 ADPKD 患者与高血压且 eGFR<60 mL/min/1.73 m2 的 ADPKD 患者的 AIx 相似（P>0.05）。与对照组相比，所有 ADPKD 患者组的 ICAM、P 选择素、E 选择素和 sFas 水平更高，而 FasL 水平更低（P<0.05）。血压正常且 eGFR≥60 mL/min/1.73 m2 的 ADPKD 患者与高血压且 eGFR<60 mL/min/1.73 m2 的 ADPKD 患者的 ICAM、P 选择素和 E 选择素相似（P>0.05）。根据多元回归分析，ADPKD 中 AIx 的预测因子包括年龄、身高、心率和平均动脉压（P<0.05）。血管炎症标志物不是 ADPKD 中 AIx 的预测因子。
结论
在年轻的、血压正常的、肾功能正常的 ADPKD 患者中，全身血管功能障碍表现为 AIx 升高和血管炎症。血管炎症与 ADPKD 中 AIx 的升高无关。
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