Ibels L S, Stewart J H, Mahony J F, Neale F C, Sheil A G
Q J Med. 1977 Apr;46(182):197-214.
The prevalence of clinical and sub-clinical occlusive arterial disease and of risk factors implicated in the pathogenesis of arteriosclerosis was assessed in 21 patients with chronic renal failure, 27 on maintenance haemodialysis and 51 renal allograft recipients. Clinical occlusive arterial disease was present in 27 patients, and sub-clinical arterial disease in 34. Myocardial infarction, cerebral thrombosis and lower limb arterial thrombosis had occurred only in the transplant recipients; these patients had, however, been followed for a longer period of time than the other two groups. In the allograft recipients, the cumulative incidence of any occlusive arterial disease was 416 per 1000, and that of coronary heart disease was 267 per 1000 at six years. Hypertension was present in 76 per cent of patients prior to renal replacement therapy. Following institution of definitive therapy, hypertension was of shorter duration and less common in haemodialysis patients than in renal transplant recipients. Uraemic and haemodialysis patients with occlusive arterial disease had required antihypertensive medication for significantly longer than those free of arterial disease. Transplant recipients with hypertension had a greater mean serum creatinine, were receiving a larger maintenance dosage of corticosteroids and less frequently had undergone prior bilateral nephrectomy than those transplant patients without hypertension. Serum lipid levels were elevated in 62 per cent of patients. In the uraemic and haemodialysis patients hypertriglyceridaemia was the predominant abnormality while in the transplant recipients combined hypertriglyceridaemia/hypercholesterolaemia was more frequent. Despite regular aluminium hydroxide therapy 81 per cent of uraemic and haemodialysis patients had a calcium X phosphate product higher than normal. Arterial and/or soft tissue calcification as demonstrable in 20-38 per cent of patients within each group, but could not be related to the calcium X phosphate product of radiographic evidence of hyperparathyroidism. Glucose intolerance was present in 71 per cent of the uraemic and haemodialysis patients and 33 per cent of the transplant recipients. Hyperuricaemia, cigarette smoking, obesity and a sedentary existence were also prevalent. The majority of patients had several risk factors implicated in the pathogenesis of arteriosclerosis. Occlusive arterial disease is a major problem in patients with end stage renal disease, being no less common after transplantation than with long-term maintenance dialysis. The aetiology is multifactorial.
对21例慢性肾衰竭患者、27例维持性血液透析患者和51例肾移植受者评估了临床和亚临床闭塞性动脉疾病以及与动脉粥样硬化发病机制相关的危险因素。27例患者存在临床闭塞性动脉疾病，34例存在亚临床动脉疾病。心肌梗死、脑血栓形成和下肢动脉血栓形成仅发生在移植受者中；然而，这些患者的随访时间比其他两组更长。在肾移植受者中，任何闭塞性动脉疾病的累积发病率在6年时为每1000人中有416例，冠心病的累积发病率为每1000人中有267例。76%的患者在进行肾脏替代治疗前患有高血压。在确定治疗方法后，高血压在血液透析患者中的持续时间较短且不如肾移植受者常见。患有闭塞性动脉疾病的尿毒症和血液透析患者需要抗高血压药物治疗的时间明显长于无动脉疾病的患者。患有高血压的移植受者的平均血清肌酐水平更高，接受的皮质类固醇维持剂量更大，且比无高血压的移植患者更少接受过双侧肾切除术。62%的患者血脂水平升高。在尿毒症和血液透析患者中，高甘油三酯血症是主要异常，而在移植受者中，高甘油三酯血症/高胆固醇血症合并症更为常见。尽管定期使用氢氧化铝治疗，但81%的尿毒症和血液透析患者的钙×磷乘积高于正常水平。每组中有20% - 38%的患者可显示动脉和/或软组织钙化，但这与甲状旁腺功能亢进的影像学证据的钙×磷乘积无关。71%的尿毒症和血液透析患者以及33%的移植受者存在葡萄糖耐量异常。高尿酸血症、吸烟、肥胖和久坐不动的生活方式也很普遍。大多数患者有几种与动脉粥样硬化发病机制相关的危险因素。闭塞性动脉疾病是终末期肾病患者的一个主要问题，在移植后与长期维持性透析一样常见。其病因是多因素的。
