Ng Hwee-Yeong, Hsueh Shu-Kai, Lee Yueh-Ting, Chiou Terry Ting-Yu, Huang Pei-Chen, Lee Chien-Te
Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Nephron. 2017;137(2):91-98. doi: 10.1159/000477827. Epub 2017 Jun 22.
Both cardiovascular calcification and autonomic dysfunction are frequently encountered in hemodialysis patients. We aimed to investigate the relationship between cardiovascular calcification and heart rate variability (HRV) and their influence on long-term outcome.
Seventy-eight hemodialysis patients underwent echocardiogram and radiography of the pelvis and hands to identify valvular and vascular calcification. HRV was evaluated using a commercial machine.
Based on the average, the patients were divided into higher and lower subgroups of high frequency (HF) and low frequency (LF) respectively. Patients with higher LF were younger and were found to have a lower proportion of diabetes. Their hemoglobin, albumin, and bone morphogenic protein (BMP)-7 levels were significantly higher and both high-sensitive C-reactive protein (hs-CRP) and osteoprotegerin levels were lower (all p < 0.05). In patients of the higher HF group, the proportion of diabetes was lower but they were found to have higher levels of BMP-7 and lower levels of hs-CRP, interleukin-6 (all p < 0.05). Significantly higher LF and HF were noted in patients without vascular calcification, but only hand artery (HA) calcification was negatively correlated with both LF and HF in multivariate analysis. Low LF and high hs-CRP were the independent predictors of mortality. Coexistence of low LF band and HA calcification was associated with the worse outcome.
Abnormal autonomic nervous function was closely related to inflammation and mortality in hemodialysis patients. Calcification of HA was associated with autonomic dysfunction and patients with lower autonomic tone and HA calcification had the highest mortality rate in this population.
心血管钙化和自主神经功能障碍在血液透析患者中很常见。我们旨在研究心血管钙化与心率变异性（HRV）之间的关系及其对长期预后的影响。
78例血液透析患者接受了超声心动图检查以及骨盆和手部的X线检查，以确定瓣膜和血管钙化情况。使用商用仪器评估HRV。
根据平均值，患者分别被分为高频（HF）和低频（LF）的较高和较低亚组。LF较高的患者更年轻，且糖尿病比例较低。他们的血红蛋白、白蛋白和骨形态发生蛋白（BMP）-7水平显著更高，而高敏C反应蛋白（hs-CRP）和骨保护素水平更低（均p<0.05）。在HF较高组的患者中，糖尿病比例较低，但他们的BMP-7水平较高，hs-CRP、白细胞介素-6水平较低（均p<0.05）。无血管钙化的患者LF和HF显著更高，但在多变量分析中只有手部动脉（HA）钙化与LF和HF均呈负相关。低LF和高hs-CRP是死亡的独立预测因素。LF波段低和HA钙化共存与更差的预后相关。
血液透析患者自主神经功能异常与炎症和死亡率密切相关。HA钙化与自主神经功能障碍有关，自主神经张力较低且有HA钙化的患者在该人群中死亡率最高。
