终末期肾病患者桡动脉钙化的组织病理学评估。

Histopathological assessment of radial artery calcification in patients with end-stage kidney disease.

机构信息

Department of Nephrology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, PR China.

Department of Pathology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, PR China.

出版信息

Ren Fail. 2021 Dec;43(1):362-370. doi: 10.1080/0886022X.2021.1889600.

DOI:10.1080/0886022X.2021.1889600

PMID:33685341

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7946001/

Abstract

BACKGROUND

A comprehensive understanding of vascular calcification pathology is significant for the development of cardiovascular disease therapy in high-risk populations. This cross-sectional study aimed to evaluate the prevalence and characteristics of radial artery calcification (RAC) and to identify the factors that are associated with RAC in end-stage kidney disease (ESKD).

METHODS

Detailed medical histories of 180 patients with ESKD were recorded. Fragments of the radial artery obtained during the creation of arteriovenous fistula for hemodialysis access were stained with alizarin red S.

RESULTS

Calcification was localized in the arterial media layer. The prevalence of positive calcification staining in the radial arteries was 21.1% ( = 38). Patients with RAC had a higher glycated hemoglobin level ( < 0.01), higher prevalence of dialysis duration >5 years ( = 0.022), and diabetes mellitus ( < 0.01) than those without RAC. Multiple logistic regression models showed dialysis duration >5 years (odds ratio [OR], 9.864; 95% confidence interval [CI], 2.666-36.502; < 0.01) and diabetes mellitus (OR, 12.689; 95% CI, 2.796-34.597; < 0.01) were independent risk factors for RAC in patients with ESKD. Patients with dialysis duration >5 years had a higher prevalence of RAC ( = 0.012) than those with dialysis duration ≤5 years. Patients with diabetes mellitus had a higher prevalence of RAC ( < 0.01) than those without diabetes mellitus. Patients with diabetes mellitus ≥15 years had a higher prevalence of RAC ( = 0.042) than those with diabetes mellitus <15 years. Radial artery calcification level showed a significantly positive correlation with dialysis duration ( < 0.05), diabetes mellitus duration ( < 0.01), HbA1c level ( < 0.01) and Calcium level ( < 0.01).

CONCLUSIONS

In patients with ESKD, dialysis duration >5 years and diabetes predict RAC. Thus, the combination of prolonged dialysis and hyperglycemic conditions exerts a synergistic effect on RAC.

摘要

背景

全面了解血管钙化病理对于高危人群心血管疾病治疗的发展具有重要意义。本横断面研究旨在评估桡动脉钙化（RAC）的患病率和特征，并确定与终末期肾病（ESKD）患者 RAC 相关的因素。

方法

详细记录了 180 名 ESKD 患者的病史。在为血液透析通路创建动静脉瘘时获得的桡动脉片段用茜素红 S 染色。

结果

钙化定位于动脉中膜层。桡动脉阳性钙化染色的患病率为 21.1%（ = 38）。与无 RAC 患者相比，RAC 患者的糖化血红蛋白水平更高（ < 0.01），透析时间>5 年的患病率更高（ = 0.022），糖尿病的患病率更高（ < 0.01）。多因素逻辑回归模型显示，透析时间>5 年（比值比 [OR]，9.864；95%置信区间 [CI]，2.666-36.502； < 0.01）和糖尿病（OR，12.689；95%CI，2.796-34.597； < 0.01）是 ESKD 患者 RAC 的独立危险因素。透析时间>5 年的患者 RAC 患病率较高（ = 0.012），而透析时间≤5 年的患者则较低。糖尿病患者的 RAC 患病率较高（ < 0.01），而非糖尿病患者则较低。糖尿病≥15 年的患者的 RAC 患病率较高（ = 0.042），而糖尿病<15 年的患者则较低。桡动脉钙化程度与透析时间（ < 0.05）、糖尿病病程（ < 0.01）、HbA1c 水平（ < 0.01）和钙水平（ < 0.01）呈显著正相关。