Genctoy Gultekin, Eldem Olcay, Ergun Tarkan, Arikan Serap
Department of Nephrology, Faculty of Medicine, Baskent University, Alanya/Antalya, Turkey.
Department of Cardiology, Faculty of Medicine, Baskent University, Alanya/Antalya, Turkey.
Artif Organs. 2015 Sep;39(9):748-55. doi: 10.1111/aor.12463. Epub 2015 May 1.
Cardiac valvular calcification (CVC) in end-stage renal disease is shown to be a component of malnutrition, inflammation, atherosclerosis, calcification (MIAC) syndrome. Thoracic periaortic fat tissue (T-PAFT) is shown to be increased in patients with end-stage renal disease (ESRD), and has positive correlation with MIAC. Negative correlation between CVC and vitamin D is shown in hemodialysis (HD) patients. In this study, we investigated a relationship between body composition, T-PAFT, metabolic and inflammatory parameters, and CVC in HD patients. Seventy-six HD patients (49M) were included. CVC is defined as bright echoes of >1 mm on one or more cusps on echocardiography. Results were expressed as the number of calcified valves (0,1,2). Calcium, phosphorus, parathyroid hormone (PTH), C-reactive protein (CRP), albumin and 25-hydroxy vitamin D levels were studied from predialysis blood samples. T-PAFT was calculated using a method with manual definition of borders on images from multislice computed tomography. Basal metabolic rate, muscle mass, total and truncal fat mass were measured by bioimpedance analysis. There were 65.8% of patients who had CVC. Patients with CVC were older (63.5 ± 14.6 ± 17, P = 0.02). T-PAFT (1599 ± 596, 739.7 ± 179 mm(2) , P = 0.001) and CRP (15.8 ± 11; 11.1 ± 13.2 mg/dL; P = 0.04) were higher in the group with CVC. T-PAFT had positive correlations with CRP, MIAC, body mass index (BMI) and number of calcified valves, negative correlation with left ventricular ejection fraction, and no correlation with albumin, calcium, phosphorus, and PTH. The logistic regression analysis revealed that T-PAFT was a significant predictor of CVC. In this study, T-PAFT showed a positive correlation with inflammation, CVC, and MIAC score in HD patients. T-PAFT was a significant predictor of CVC.
终末期肾病中的心脏瓣膜钙化（CVC）被证明是营养不良、炎症、动脉粥样硬化、钙化（MIAC）综合征的一个组成部分。终末期肾病（ESRD）患者的胸主动脉周围脂肪组织（T-PAFT）增多，且与MIAC呈正相关。血液透析（HD）患者中CVC与维生素D呈负相关。在本研究中，我们调查了HD患者的身体成分、T-PAFT、代谢和炎症参数与CVC之间的关系。纳入了76例HD患者（49例男性）。CVC定义为超声心动图上一个或多个尖瓣上>1毫米的明亮回声。结果以钙化瓣膜的数量（0、1、2）表示。从透析前血样中研究钙、磷、甲状旁腺激素（PTH）、C反应蛋白（CRP）、白蛋白和25-羟基维生素D水平。使用在多层计算机断层扫描图像上手动定义边界的方法计算T-PAFT。通过生物电阻抗分析测量基础代谢率、肌肉质量、总脂肪量和躯干脂肪量。有65.8%的患者存在CVC。有CVC的患者年龄更大（63.5±14.6±17，P=0.02）。CVC组的T-PAFT（1599±596，739.7±179mm²，P=0.001）和CRP（15.8±11；11.1±13.2mg/dL；P=0.04）更高。T-PAFT与CRP、MIAC、体重指数（BMI）和钙化瓣膜数量呈正相关，与左心室射血分数呈负相关，与白蛋白、钙、磷和PTH无相关性。逻辑回归分析显示T-PAFT是CVC的显著预测因子。在本研究中，T-PAFT在HD患者中与炎症、CVC和MIAC评分呈正相关。T-PAFT是CVC的显著预测因子。
