Sharma Jugal, Kapoor Aditya, Muthu Ranjanee, Prasad Narayan, Sinha Archana, Khanna Roopali, Kumar Sudeep, Garg Naveen, Tewari Satyendra, Sharma Raj K, Goel Pravin
Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India.
Clin Transplant. 2014 Aug;28(8):889-96. doi: 10.1111/ctr.12398. Epub 2014 Jul 8.
Endothelial dysfunction may explain increased cardiovascular risk in patients with chronic kidney disease (CKD).
Brachial artery was imaged during reactive hyperemia (endothelium-dependent, flow-mediated dilatation, FMD) and during glyceryl trinitrate-mediated dilatation (nitroglycerine-mediated dilatation, NMD, endothelium-independent) in 108 patients with CKD and three months following renal transplantation (RT) in 60 of them.
Patients with CKD had significantly lower FMD vs. controls (9.1% vs. 18.3%, p < 0.001) while NMD was comparable (19.8% vs. 21.8%, p = ns). Impaired FMD (<4.5%) was observed in 26.8% patients with CKD and was more common in those on hemodialysis (HD; 28.4% vs. 15.4%) vs. those not on dialysis. FMD for patients with glomerular filtration rate (GFR) 15-60 vs. <15 mL/min/1.73 m(2) was 12.9% and 8.8% (p = 0.05; respectively -29% and -52% lower vs. controls), indicating reduced FMD with increasing CKD severity. There was +72% increase in FMD following RT (9.1 to 15.7%, p < 0.001) while mean NMD was unchanged. Following RT, only 3.3% had impaired FMD.
Patients with CKD have endothelial dysfunction as evidenced by reduced FMD. Decreased FMD indicating worsening endothelial function was noted with increasing severity of CKD. Within three months of RT, there was significant improvement in FMD, while NMD values did not change.
内皮功能障碍可能解释慢性肾脏病（CKD）患者心血管风险增加的原因。
对108例CKD患者在反应性充血期间（内皮依赖性、血流介导的血管舒张，FMD）和硝酸甘油介导的血管舒张期间（硝酸甘油介导的血管舒张，NMD，非内皮依赖性）进行肱动脉成像，其中60例患者在肾移植（RT）后三个月也进行了成像。
CKD患者的FMD显著低于对照组（9.1%对18.3%，p<0.001），而NMD相当（19.8%对21.8%，p=无统计学意义）。26.8%的CKD患者观察到FMD受损（<4.5%），在接受血液透析（HD）的患者中更常见（28.4%对15.4%），而非透析患者。肾小球滤过率（GFR）为15 - 60与<15 mL/min/1.73 m²的患者的FMD分别为12.9%和8.8%（p = 0.05；分别比对照组低29%和52%），表明随着CKD严重程度增加FMD降低。RT后FMD增加了72%（从9.1%增至15.7%，p<0.001），而平均NMD未改变。RT后，只有3.3%的患者FMD受损。
CKD患者存在内皮功能障碍，表现为FMD降低。随着CKD严重程度增加，FMD降低表明内皮功能恶化。在RT后三个月内，FMD有显著改善，而NMD值未改变。
