Gueiros Ana Paula Santana, Gueiros José Edevanilson de Barros, Nóbrega Karina Tavares, Calado Eveline Barros, Matta Marina Cadena da, Torres Leuridan Cavalcante, Souza Alex Sandro Rolland, Casarini Dulce Elena, Carvalho Aluizio Barbosa de
Instituto de Medicina Integral Professor Fernando Figueira, Serviço de Nefrologia, Recife, PE, Brasil.
Instituto de Medicina Integral Professor Fernando Figueira, Serviço de Radiologia, Recife, PE, Brasil.
J Bras Nefrol. 2019 Aug 15;41(3):345-355. doi: 10.1590/2175-8239-jbn-2019-0009.
There is evidence that aldosterone plays a role in the pathogenesis of vascular calcification. The aim of this study was to evaluate the effect of spironolactone, a mineralocorticoid receptor antagonist, on the progression of coronary calcification (CC) in peritoneal dialysis patients and to identify the factors involved in this progression.
Thirty-three patients with a coronary calcium score (CCS) ≥ 30, detected through multi-detector computed tomography (MDCT) and expressed in Agatston units, were randomly assigned to a group receiving 25mg spironolactone per day for 12 months (spironolactone group) and a control group not receiving this drug. The primary outcome was a percentage change in CCS from baseline to end of the study (relative progression), when a further MDCT was conducted. Patients who had progression of CC were compared with those who did not progress.
Sixteen patients, seven in the spironolactone group and nine in the control group, concluded the study. The relative progression of the CCS was similar in both groups, 17.2% and 27.5% in the spironolactone and control groups respectively. Fifty-seven percent of the treated patients and 67% of those in the control group presented progression in the CC scores (p = 0.697). Progressor patients differed from non-progressors because they presented higher levels of calcium and low-density lipoprotein cholesterol and lower levels of albumin.
In peritoneal dialysis patients, spironolactone did not attenuate the progression of CC. However, large-scale studies are needed to confirm this observation. Disorders of mineral metabolism and dyslipidemia are involved in the progression of CC.
有证据表明醛固酮在血管钙化的发病机制中起作用。本研究的目的是评估盐皮质激素受体拮抗剂螺内酯对腹膜透析患者冠状动脉钙化（CC）进展的影响，并确定参与这一进展的因素。
通过多排螺旋计算机断层扫描（MDCT）检测出33例冠状动脉钙化积分（CCS）≥30（以阿加斯顿单位表示）的患者，将其随机分为两组，一组每天服用25mg螺内酯，持续12个月（螺内酯组），另一组为未服用该药物的对照组。主要结局是在研究结束时（进行进一步MDCT检查时）CCS相对于基线的百分比变化（相对进展）。将发生CC进展的患者与未进展的患者进行比较。
16例患者完成了研究，其中螺内酯组7例，对照组9例。两组CCS的相对进展相似，螺内酯组和对照组分别为17.2%和27.5%。治疗组中57%的患者和对照组中67%的患者CC评分出现进展（p = 0.697）。进展患者与未进展患者的不同之处在于，前者的钙和低密度脂蛋白胆固醇水平较高，而白蛋白水平较低。
在腹膜透析患者中，螺内酯并未减轻CC的进展。然而，需要大规模研究来证实这一观察结果。矿物质代谢紊乱和血脂异常与CC的进展有关。
