School of Nephrology, Department of Clinical and Experimental Medicine, University of Catania, Italy.
Nephrology & Dialysis, San Bassiano Hospital, Bassano del Grappa, Italy.
Eur J Intern Med. 2018 Jan;47:36-42. doi: 10.1016/j.ejim.2017.08.020. Epub 2017 Aug 19.
We hypothesized that a reversal of the physiological stiffness gradient, previously reported in end-stage renal disease, begins in the early stages of chronic kidney disease (CKD) and that chronic inflammation produces a different arterial phenotype in patients with ulcerative colitis (UC).
To assess the extent of arterial stiffening in the central (carotid-femoral pulse wave velocity, cf.-PWV) and peripheral arteries (carotid-radial pulse wave velocity, cr-PWV) and to explore the determinants of the stiffness gradient in UC and in CKD.
We enrolled 45 patients with UC, 45 patients with stage 3-4 CKD and 45 matched controls.
Despite the comparable cf.-PWV, the cr-PWV was higher in patients with UC than in those with CKD (median: 8.7 vs. 7.5m/s; p<0.001) and, consequently, the PWV ratio was lower (median: 0.97 vs. 1.12; p<0.001). In patients with CKD a stiffness mismatch was reported starting from stage 3B. The PWV ratio was associated with age and C-reactive protein (beta: 0.08 z-score, 95%CI 0.02-0.14; p=0.01) or active disease (beta: 0.43 z-score, 95%CI 0.003-0.857; p=0.048) in patients with UC and with age and glomerular filtration rate (beta: -0.56 z-score, 95%CI -1.05 to -0.07; p=0.02) in patients with CKD.
The arterial phenotype differed between UC and CKD. The reversal of the arterial stiffness gradient is evident in CKD patients starting from stage 3B but not in patients with UC and comparable cf.-PWV. In patients with UC, the stiffness of both elastic and muscular arteries is increased as a consequence of inflammation.
我们假设，在终末期肾病中观察到的生理僵硬梯度的逆转，在慢性肾脏病（CKD）的早期阶段就开始了，并且慢性炎症在溃疡性结肠炎（UC）患者中产生了不同的动脉表型。
评估中央（颈动脉-股动脉脉搏波速度，cf.-PWV）和外周动脉（颈动脉-桡动脉脉搏波速度，cr-PWV）的动脉僵硬程度，并探讨 UC 和 CKD 中僵硬梯度的决定因素。
我们纳入了 45 例 UC 患者、45 例 3-4 期 CKD 患者和 45 例匹配的对照者。
尽管 cf.-PWV 相当，UC 患者的 cr-PWV 高于 CKD 患者（中位数：8.7 与 7.5m/s；p<0.001），因此，PWV 比值较低（中位数：0.97 与 1.12；p<0.001）。在 CKD 患者中，从 3B 期开始就报告了僵硬不匹配。PWV 比值与年龄和 C 反应蛋白（β：0.08 个 z 评分，95%CI 0.02-0.14；p=0.01）或活动期疾病（β：0.43 z 评分，95%CI 0.003-0.857；p=0.048）相关，在 UC 患者中，与年龄和肾小球滤过率（β：-0.56 z 评分，95%CI -1.05 至 -0.07；p=0.02）相关，在 CKD 患者中。
UC 和 CKD 之间的动脉表型不同。在 CKD 患者中，从 3B 期开始就出现了动脉僵硬梯度的逆转，但在 UC 患者中没有出现，且 cf.-PWV 相当。在 UC 患者中，弹性和肌性动脉的僵硬程度都因炎症而增加。
