Zahran Manal, Nasr Fatma Mohammed, Metwaly Amna Ahmed, El-Sheikh Noha, Khalil Nevine Sherif Ali, Harba Tarek
Clinical Chemistry Department, Theodor Bilharz Research Institute, Cairo, Egypt.
Intensive Care Department, Theodor Bilharz Research Institute, Cairo, Egypt.
Electron Physician. 2015 Sep 16;7(5):1270-6. doi: 10.14661/1270. eCollection 2015 Sep.
Atherosclerotic cardiovascular disease remains the leading cause of increased morbidity and mortality observed in chronic kidney disease (CKD) patients. Endothelial dysfunction (ED) is thought to be a key initial event in the development of atherosclerosis. The aim of this study was to evaluate the potential role of hemostatic factors in atherosclerosis, thrombosis and cardiovascular complications in patients suffering from chronic renal disease.
The study was conducted on 50 renal patients divided into two groups of equal size. Group 1 consisted of 25 patients with end-stage renal disease (ESRD) on regular hemodialysis. Group 2 consisted of 25 chronic renal disease patients on conservative treatment. Twenty age- and sex-matched healthy subjects were included in the study to serve as a control group. Thrombomodulin (TM), von Willebrand factor (vWF), tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1) and hsCRP were assessed. High-resolution B-mode ultrasonography of both the common and internal carotid arteries to measure carotid intima media thickness (CIMT) was performed on all subjects.
There were highly significant increases in hsCRP, TM, vWF, tPA and PAI-1 in both patient groups compared to the control group (P<0.01 for all except for TM between group 2 and 3 P<0.05) with significant increase in group 1 compared to group 2 (P<0.01). In addition, there was a highly significant increase in CIMT in both patient groups compared to the control group (P<0.01) with a significant increase in group 1 compared to group 2 (P<0.05). The study revealed significant positive correlation of hemostatic factors (TM, vWf, PAI-1 & t-PA) with creatinine, urea, hsCRP & CIMT.
CKD patients have increased risk of atherosclerosis as measured by CIMT, which is used as a surrogate marker of early atherosclerosis and has been shown to be a strong predictor of future myocardial infarction and stroke. They have high levels of TM, vWF, tPA, PAI-1 that correlate with kidney function, hsCRP and CIMT. Therefore, these abnormalities in hemostasis may account for the increased risk of atherothrombosis in these patients. The elevated hsCRP levels and their correlation to hemostatic factors and CIMT might provide an important clue to link a systemic marker of inflammation to atherosclerosis. Further research is required to better understand the procoagulant state in patients with CKD.
动脉粥样硬化性心血管疾病仍然是慢性肾脏病（CKD）患者发病率和死亡率增加的主要原因。内皮功能障碍（ED）被认为是动脉粥样硬化发展过程中的关键初始事件。本研究的目的是评估止血因子在慢性肾脏病患者动脉粥样硬化、血栓形成和心血管并发症中的潜在作用。
该研究对50例肾病患者进行，分为两组，每组人数相等。第1组由25例接受定期血液透析的终末期肾病（ESRD）患者组成。第2组由25例接受保守治疗的慢性肾病患者组成。20名年龄和性别匹配的健康受试者被纳入研究作为对照组。评估了血栓调节蛋白（TM）、血管性血友病因子（vWF）、组织型纤溶酶原激活剂（t-PA）、纤溶酶原激活剂抑制剂（PAI-1）和高敏C反应蛋白（hsCRP）。对所有受试者进行双侧颈总动脉和颈内动脉的高分辨率B型超声检查，以测量颈动脉内膜中层厚度（CIMT）。
与对照组相比，两组患者的hsCRP、TM、vWF、tPA和PAI-1均显著升高（除第2组和第3组之间的TM，P<0.05外，其余均P<0.01），第1组与第2组相比显著升高（P<0.01）。此外，与对照组相比，两组患者的CIMT均显著升高（P<0.01），第1组与第2组相比显著升高（P<0.05）。研究显示止血因子（TM、vWf、PAI-1和t-PA）与肌酐、尿素、hsCRP和CIMT之间存在显著正相关。
通过CIMT测量，CKD患者发生动脉粥样硬化的风险增加，CIMT用作早期动脉粥样硬化的替代标志物，并且已被证明是未来心肌梗死和中风的有力预测指标。他们的TM、vWF、tPA、PAI-1水平较高，这些指标与肾功能、hsCRP和CIMT相关。因此，这些止血异常可能解释了这些患者动脉粥样硬化血栓形成风险的增加。hsCRP水平升高及其与止血因子和CIMT之间的相关性可能为将炎症的全身标志物与动脉粥样硬化联系起来提供重要线索。需要进一步研究以更好地了解CKD患者的促凝状态。
