肾素-血管紧张素-醛固酮系统阻断与肾移植受者动脉僵硬：一项横断面前瞻性观察性临床研究。

The renin-angiotensin-aldosterone system blockade and arterial stiffness in renal transplant recipients - a cross-sectional prospective observational clinical study.

机构信息

Department of Nephrology, Transplantology and Internal Medicine Medical University of Gdansk, Poland, Gdańsk, Poland.

Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin Charité - Universitätsmedizin Berlin, Germany.

出版信息

Acta Biochim Pol. 2020 Dec 17;67(4):613-622. doi: 10.18388/abp.2020_5490.

DOI:10.18388/abp.2020_5490

PMID:33332078

Abstract

INTRODUCTION

Arterial stiffness parameters can be used as a predictor of cardiovascular events in the general population and renal transplant recipients (RTRs). Additionally, the renin-angiotensin-aldosterone-system (RAAS) blockade mitigates arterial stiffness in the general population. There are no sufficient data concerning the role of the RAAS blockade in reducing arterial stiffness among patients after kidney transplantation. The aim of this study is to assess the influence of the above blockade on arterial stiffness in RTRs.

METHODS

344 stable RTRs were enrolled in the study. 204 (59.3%) of them received RAAS blockers (angiotensin convertase inhibitors - ACEIs or angiotensin receptor blockers - ARBs): group RAAS (+), and 140 (40.7%) were not treated with such agents: group RAAS (-).

RESULTS

In the RAAS (+) group, 55.9% of the patients used ARBs and 44.1% ACEIs. Cardiovascular disease (coronary artery disease and/or peripheral obliterans artery disease) (27.9% vs 14.3%, p<0.05), and heart failure (27.4% vs 24.3%, p<0.05) were significantly more often diagnosed in the RAAS (+) group when compared to the RAAS (-) group. Systolic blood pressure, diastolic blood pressure and all arterial stiffness parameters (baPWV, cfPWV, pulse pressure) did not differ significantly between the RAAS (+) and RAAS (-) groups. The results revealed that cardiovascular disease in patients was associated with a significant increase in both, the PWV and pulse pressure. No difference between the arterial stiffness parameters was observed in patients with a cardiovascular disease, diabetes and heart failure in the RAAS (+) and RAAS (-) groups. Moreover, beta-blockers and diuretics ameliorated the arterial stiffness parameters.

CONCLUSIONS

This study showed the indication bias of the RAAS prescription, and no conclusion on the influence of RAAS on arterial stiffness can be drawn. The results indicated diuretics and beta-blockers as agents lowering the arterial stiffness in RTRs.

摘要

简介

动脉僵硬度参数可作为一般人群和肾移植受者（RTR）心血管事件的预测指标。此外，肾素-血管紧张素-醛固酮系统（RAAS）阻滞剂可减轻一般人群的动脉僵硬度。关于 RAAS 阻滞剂在减少肾移植后患者动脉僵硬度方面的作用，尚无充分的数据。本研究旨在评估上述阻滞对 RTR 动脉僵硬度的影响。

方法

纳入 344 例稳定的 RTR 进行研究。其中 204 例（59.3%）接受 RAAS 阻滞剂（血管紧张素转换酶抑制剂 - ACEI 或血管紧张素受体阻滞剂 - ARB）：RAAS（+）组，140 例（40.7%）未接受此类药物治疗：RAAS（-）组。

结果

在 RAAS（+）组中，55.9%的患者使用 ARB，44.1%使用 ACEI。与 RAAS（-）组相比，RAAS（+）组中更常诊断出心血管疾病（冠状动脉疾病和/或外周动脉闭塞性疾病）（27.9%比 14.3%，p<0.05）和心力衰竭（27.4%比 24.3%，p<0.05）。与 RAAS（-）组相比，RAAS（+）组的收缩压、舒张压和所有动脉僵硬度参数（baPWV、cfPWV、脉压）无显著差异。结果表明，患者的心血管疾病与 PWV 和脉压的显著增加相关。在 RAAS（+）和 RAAS（-）组中，患有心血管疾病、糖尿病和心力衰竭的患者之间，动脉僵硬度参数无差异。此外，β受体阻滞剂和利尿剂可改善动脉僵硬度参数。