Clinic for Vascular Surgery, Klinikum rechts der Isar and German Heart Centre Munich, Technische Universität München, München, Germany.
J Vasc Surg. 2011 Dec;54(6):1643-9. doi: 10.1016/j.jvs.2011.05.049. Epub 2011 Jul 20.
Little is known about the effect of chronic kidney disease (CKD) on plaque morphology in cerebral vessels. We therefore analyzed plaque composition and metabolic and chemical parameters with regard to clinical outcome in patients with advanced carotid artery stenosis (>70%) and normal or impaired renal function.
Carotid endarterectomy plaques were collected from 114 patients, 51 with CKD and 63 without CKD (mean estimated glomerular filtration rate, 49 ± 9 vs 88 ± 14 mL/min), and analyzed by histology and immunohistochemistry. Serum levels of matrix metalloproteinases (MMP-1, -2, -3, -7, -8, and -9), calcium, phosphate, parathyroid hormone, fetuin-A, osteoprotegerin, and inflammatory factors, including fibrinogen, and high-sensitive C-reactive protein (hsCRP) were measured by appropriate enzyme-linked immunosorbent assay.
Compared with patients without CKD, patients with CKD had significantly more early-stage (11.2% vs 2.8%, P = .002) and end-stage (7.4% vs 0.2%, P = .036) calcification, unstable (50.8% vs 20.4%, P = .001) and ruptured (53.1% vs 32.8%, P = .035) lesions, and a significantly lower amount of collagenous fibers (39.2% vs 54.6%, P = .001). Serum samples of CKD patients had significantly enhanced levels of fibrinogen (393 ± 88 vs 331 ± 60 mg/dL, P = .018), hsCRP (1.7 ± 2.9 vs 0.8 ± 0.9 mg/dL; P = .042), parathyroid hormone (47.3 ± 24.1 vs 32.8 ± 12.2 ng/L, P = .010), fetuin-A (0.21 ± 0.05 vs 0.18 ± 0.04 mg/mL, P = .039), and MMP-7 (13.0 ± 5.3 vs 8.3 ± 3.0 ng/mL; P < 0.001). The incidence of cerebrovascular events >6 months before carotid surgery was significantly increased in CKD patients (84.0% vs 26.2% P < .001).
In patients with CKD and advanced carotid artery stenosis, morphologic changes in plaque composition may contribute to plaque vulnerability and consequently to the risk of cerebrovascular events. Furthermore, relevant serum markers of inflammation, vascular calcification, and vessel wall degradation might be an indication of stroke risk in CKD patients.
关于慢性肾脏病（CKD）对脑血管斑块形态的影响知之甚少。因此，我们分析了颈动脉狭窄程度大于 70%且肾功能正常或受损的患者的斑块成分以及代谢和化学参数与临床结局的关系。
对 114 例颈动脉内膜切除术斑块进行分析，其中 51 例患者患有 CKD，63 例患者无 CKD（平均估计肾小球滤过率分别为 49±9ml/min 和 88±14ml/min），通过组织学和免疫组织化学进行分析。通过适当的酶联免疫吸附试验测定基质金属蛋白酶（MMP-1、-2、-3、-7、-8 和-9）、钙、磷、甲状旁腺激素、胎球蛋白 A、骨保护素和炎症因子（包括纤维蛋白原和高敏 C 反应蛋白[hsCRP]）的血清水平。
与无 CKD 的患者相比，患有 CKD 的患者早期（11.2%对 2.8%，P=.002）和晚期（7.4%对 0.2%，P=.036）钙化、不稳定（50.8%对 20.4%，P=.001）和破裂（53.1%对 32.8%，P=.035）病变更多，胶原纤维含量显著降低（39.2%对 54.6%，P=.001）。CKD 患者的血清样本中纤维蛋白原（393±88 对 331±60mg/dL，P=.018）、hsCRP（1.7±2.9 对 0.8±0.9mg/dL；P=.042）、甲状旁腺激素（47.3±24.1 对 32.8±12.2ng/L，P=.010）、胎球蛋白 A（0.21±0.05 对 0.18±0.04mg/mL，P=.039）和 MMP-7（13.0±5.3 对 8.3±3.0ng/mL；P<.001）水平显著升高。颈动脉手术前 6 个月以上发生脑血管事件的 CKD 患者发生率显著升高（84.0%对 26.2%，P<.001）。
在患有 CKD 和严重颈动脉狭窄的患者中，斑块成分形态变化可能导致斑块易损性，并因此导致脑血管事件的风险增加。此外，炎症、血管钙化和血管壁降解的相关血清标志物可能是 CKD 患者中风风险的一个迹象。
