慢性肾脏病与血管平滑肌功能障碍有关，但与内皮功能障碍无关。

Chronic kidney disease is associated with vascular smooth muscle dysfunction but not with endothelial dysfunction.

机构信息

Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Division of Regeneration and Medicine, Hiroshima University Hospital, Hiroshima, Japan.

出版信息

Int J Cardiol. 2018 Mar 1;254:284-290. doi: 10.1016/j.ijcard.2017.10.122. Epub 2018 Jan 28.

DOI:10.1016/j.ijcard.2017.10.122

PMID:29407110

Abstract

BACKGROUNDS

Nitroglycerine-induced vasodilation (NID) is usually assessed as a control test for flow-mediated vasodilation (FMD). However, NID per se is impaired in patients with high cardiovascular risk. The purpose of this study was to investigate the associations of chronic kidney disease (CKD) with NID and FMD.

METHODS

We measured NID and FMD in a total of 1567 adult subjects without end-stage renal disease (ESRD), 28% of whom had CKD as judged by measurements of estimated glomerular filtration rate (995 men and 572 women; mean age, 59.0±16.9years; age range, 18 to 92years).

RESULTS

NID was significantly smaller in patients with CKD than in those without CKD (10.8±6.0% vs. 12.7±5.7%, P<0.001). The prevalence of vascular smooth muscle dysfunction, defined as NID of less than the division point for the lowest quartile, was significantly higher in patients with CKD than in those without CKD (37.5% vs. 21.5%, P<0.001). Multivariate analysis revealed that CKD was independently associated with vascular smooth muscle dysfunction (OR: 1.36, 95% CI: 1.02 to 1.81, P=0.04). FMD was significantly smaller in patients with CKD than in those without CKD (3.1±2.8% vs. 4.0±3.0%, P<0.001). The prevalence of endothelial dysfunction, defined as FMD of less than the division point for the lowest quartile, was significantly higher in patients with CKD than in those without CKD (31.7% vs. 23.1%, P=0.002). However, CKD was not independently associated with endothelial dysfunction in an age- and sex-adjusted model (OR: 0.95, 95% CI: 0.71 to 1.26, P=0.72).

CONCLUSIONS

Non-ESRD CKD is independently associated with vascular smooth muscle dysfunction but not with endothelial dysfunction.

摘要

背景

硝酸甘油诱导的血管舒张（NID）通常被评估为血流介导的血管舒张（FMD）的对照试验。然而，患有高心血管风险的患者本身的 NID 就会受损。本研究的目的是探讨慢性肾脏病（CKD）与 NID 和 FMD 的关系。

方法

我们共测量了 1567 名无终末期肾病（ESRD）的成年患者的 NID 和 FMD，其中 28%的患者根据估算肾小球滤过率（995 名男性和 572 名女性；平均年龄 59.0±16.9 岁；年龄范围 18 至 92 岁）判断患有 CKD。

结果

与无 CKD 的患者相比，患有 CKD 的患者的 NID 明显更小（10.8±6.0%对 12.7±5.7%，P<0.001）。患有 CKD 的患者中，血管平滑肌功能障碍的患病率（定义为 NID 低于最低四分位数的分界点）明显高于无 CKD 的患者（37.5%对 21.5%，P<0.001）。多变量分析显示，CKD 与血管平滑肌功能障碍独立相关（OR：1.36，95%CI：1.02 至 1.81，P=0.04）。与无 CKD 的患者相比，患有 CKD 的患者的 FMD 明显更小（3.1±2.8%对 4.0±3.0%，P<0.001）。患有 CKD 的患者中，内皮功能障碍的患病率（定义为 FMD 低于最低四分位数的分界点）明显高于无 CKD 的患者（31.7%对 23.1%，P=0.002）。然而，在年龄和性别调整模型中，CKD 与内皮功能障碍并不独立相关（OR：0.95，95%CI：0.71 至 1.26，P=0.72）。