Dégi Arianna, Kerti Andrea, Cseprekál Orsolya, Kis Éva, Sallay Péter, Szabó Attila J, Reusz George S
1st Department of Pediatrics, Semmelweis University, Budapest, Hungary.
Pediatr Transplant. 2013 Nov;17(7):598-604. doi: 10.1111/petr.12123. Epub 2013 Jul 16.
Given the increase in CV morbidity after RTx and the scarcity of CV events in pediatrics, surrogate markers should be assessed to characterize CV damage in this population. AASI is a marker of arterial stiffness in adults, predicting cardio- and cerebrovascular morbidity. Our aim was to assess the determinants of AASI in RTx children (n = 54, 15.5 ± 3.5 yr) and to examine its relationship to central PWV. AASI was calculated from 24 h ABPM. PWV was determined by applanation tonometry, body composition by multifrequency bioimpedance measurement. The dipping state, volume overload, and time on dialysis were the main predictors of AASI (p < 0.05). Children with established HT (n = 34) had increased AASI, extracellular body water, and BNP (p < 0.05). In contrast to AASI, PWV did not differ between HT and normotensive RTx patient groups. There was no correlation between AASI and PWV. PWV was increased in children who spent more than one yr on dialysis prior to RTx. In conclusion, increased AASI in HT RTx children better characterizes the actual volume- and pressure-dependent arterial rigidity rather than long-term morphological changes in large arteries as reflected by PWV.
鉴于肾移植术后心血管疾病发病率增加，且儿科心血管事件较少，应评估替代标志物以表征该人群的心血管损伤。动脉僵硬度指数（AASI）是成人动脉僵硬度的标志物，可预测心血管和脑血管疾病发病率。我们的目的是评估肾移植儿童（n = 54，15.5±3.5岁）AASI的决定因素，并研究其与中心脉搏波速度（PWV）的关系。AASI由24小时动态血压监测计算得出。PWV通过压平式眼压测量法测定，身体成分通过多频生物电阻抗测量法测定。血压波动状态、容量超负荷和透析时间是AASI的主要预测因素（p<0.05）。已确诊高血压的儿童（n = 34）AASI、细胞外体液和脑钠肽（BNP）升高（p<0.05）。与AASI不同，高血压和血压正常的肾移植患者组之间PWV无差异。AASI与PWV之间无相关性。肾移植术前透析超过一年的儿童PWV升高。总之，高血压肾移植儿童AASI升高更好地表征了实际的容量和压力依赖性动脉僵硬度，而非PWV所反映的大动脉长期形态变化。
