Department of Nephrology, Saitama Medical University, Iruma gun, Saitama, Japan.
Hypertens Res. 2012 Feb;35(2):142-7. doi: 10.1038/hr.2011.155. Epub 2011 Sep 8.
Menopause is derived from the Greek words men (month) and pauses (cessation) and means permanent cessation of menstruation after the loss of ovarian activity. Chronic kidney disease (CKD) has recently been associated with cardiovascular events in several studies. CKD patients have a heavy burden of traditional cardiovascular risk factors in addition to a range of nontraditional risk factors such as inflammation and abnormal metabolism of calcium and phosphate. In this review, the association of CKD and cardiovascular disease (CVD), as well as of osteoporosis in postmenopausal women is discussed. CKD mineral and bone disorder, characterized by disturbances of calcium/phosphate/parathyroid hormone, bone abnormalities and vascular and soft tissue calcification, is highly prevalent in CKD and is a strong, independent predictor of bone fracture, CVD and death. Estrogen has been shown to: (a) decrease the expression of angiotensin type 1 receptors in vasculature and kidneys; (b) reduce the expression and activity of angiotensin-converting enzyme, and (c) cause the release of angiotensinogen substrate from the liver. However, the degree of activation or suppression of the renin-angiotensin-aldosterone system by estrogen has not been clearly established. Clinical data on the effects of estrogen therapy on bone mineral densities are extremely limited in the ESRD population. CVD is the most common cause of death in postmenopausal women with CKD and many contributing factors have been explored. Future research for prevention of CVD in postmenopausal women with CKD would focus on the biology of vascular calcification as well as bone loss.
绝经一词源自希腊语 men（月）和 pauses（停止），意思是卵巢功能丧失后月经永久性停止。多项研究表明，慢性肾脏病（CKD）与心血管事件最近有关联。CKD 患者除了传统心血管危险因素外，还存在一系列非传统危险因素，如炎症和钙、磷代谢异常，其负担沉重。在这篇综述中，讨论了 CKD 和心血管疾病（CVD）以及绝经后妇女骨质疏松症之间的关联。CKD 矿物质和骨代谢紊乱的特征是钙/磷/甲状旁腺激素紊乱、骨骼异常以及血管和软组织钙化，在 CKD 中非常普遍，是骨折、CVD 和死亡的强有力独立预测因素。雌激素已被证明：（a）降低血管和肾脏中血管紧张素 1 型受体的表达；（b）减少血管紧张素转换酶的表达和活性；（c）导致肝脏释放血管紧张素原底物。然而，雌激素对肾素-血管紧张素-醛固酮系统的激活或抑制程度尚未明确。在 ESRD 人群中，关于雌激素治疗对骨矿物质密度影响的临床数据极为有限。CVD 是 CKD 绝经后妇女中最常见的死亡原因，许多相关因素已被探索。未来对 CKD 绝经后妇女 CVD 的预防研究将集中在血管钙化和骨质流失的生物学上。
