Coronary artery calcification （CAC） is highly prevalent in patients with coronary heart disease （CHD） and is associated with major adverse cardiovascular events. There are two recognized type of CAC--intimal and m...Coronary artery calcification （CAC） is highly prevalent in patients with coronary heart disease （CHD） and is associated with major adverse cardiovascular events. There are two recognized type of CAC--intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary interven- tion have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD pa- tients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.展开更多
目的比较低通量和高通量血液透析对非糖尿病终末期肾病(end stage renal disease,ESRD)患者胰岛素抵抗(insulin resistance,IR)、炎症因子以及冠状动脉钙化(coronary artery calcification,CAC)的影响,分析影响患者预后生存的相关因素...目的比较低通量和高通量血液透析对非糖尿病终末期肾病(end stage renal disease,ESRD)患者胰岛素抵抗(insulin resistance,IR)、炎症因子以及冠状动脉钙化(coronary artery calcification,CAC)的影响,分析影响患者预后生存的相关因素。方法选取2015年2月~2017年4月于本院接受治疗的非糖尿病ESRD患者217例,按照随机数字表法分为对照组(n=108)和观察组(n=109),分别采用低通量和高通量血液透析治疗。比较2组基线资料、肾功能、脂代谢、炎症因子、IR、CAC、并发症、转归情况及卫生经济学效益。对患者随访3年,根据转归情况将其分为生存组(n=130)和死亡组(n=75),比较2组临床资料,分析影响患者预后生存的相关因素。结果治疗后,2组Scr(血肌酐)、BUN(血尿素氮)、(UAE)、UAER(尿蛋白排泄量)、TC(总胆固醇)、TG(甘油三脂)、LDL-C(低密度脂蛋白胆固醇)较治疗前显著降低[对照组:Scr(μmol/L)349.62±37.16 vs 201.73±24.58,BUN(mmol/L)28.43±5.39 vs20.81±3.47,UAER(μg/min)60.14±11.52 vs 55.73±9.86,TC(mmol/L)5.46±0.93 vs 4.75±0.69,TG(mmol/L)2.58±0.64 vs 2.13±0.57,LDL-C(mmol/L)3.69±0.73 vs2.45±0.60;观察组:Scr(μmol/L)352.14±38.29 vs 136.85±16.47,BUN(mmol/L)27.96±5.25 vs17.56±3.68,UAER(μg/min)60.32±12.07 vs 49.85±7.42,TC(mmol/L)5.48±0.97 vs 4.27±0.56,TG(mmol/L)2.55±0.62 vs 1.49±0.35,LDL-C(mmol/L)3.72±0.74 vs1.91±0.48],eGFR(肾小球滤过率)和HDL-C(高密度脂蛋白胆固醇)较治疗前显著升高[对照组:eGFR(mL/min/1.73m)29.32±3.25 vs 72.54±7.86,HDL-C(mmol/L)1.13±0.24 vs1.28±0.31,观察组:eGFR(mL/min/1.73m)30.05±3.29 vs121.63±13.34,HDL-C(mmol/L)1.09±0.22 vs 1.57±0.46],P<0.05;2组FBG(空腹血糖)、FINS(空腹胰岛素)、HOMA-IR(胰岛素抵抗指数)、IL-6(白介素-6)、IL-8(白介素-8)、TNF-α(肿瘤坏死因子-α)及hs-CRP(超敏C反应蛋白)均较治疗前显著降低[对照组:FBG(mmol/L)4.99±0.95 vs 4.52±0.63,FINS(mU/L)12.93±2.54 vs10.15±2.21,HOMA-IR 2.87±0.54 vs 2.04±0.43,IL-6(pg/展开更多
基金This work were supported by the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support （No. ZYLX201303）, the National Natural Science Foundation of China （No. 81470429, No.81270285）, and The capital health research and development of special （No 2011-2006-14）.
文摘Coronary artery calcification （CAC） is highly prevalent in patients with coronary heart disease （CHD） and is associated with major adverse cardiovascular events. There are two recognized type of CAC--intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary interven- tion have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD pa- tients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.
文摘目的比较低通量和高通量血液透析对非糖尿病终末期肾病(end stage renal disease,ESRD)患者胰岛素抵抗(insulin resistance,IR)、炎症因子以及冠状动脉钙化(coronary artery calcification,CAC)的影响,分析影响患者预后生存的相关因素。方法选取2015年2月~2017年4月于本院接受治疗的非糖尿病ESRD患者217例,按照随机数字表法分为对照组(n=108)和观察组(n=109),分别采用低通量和高通量血液透析治疗。比较2组基线资料、肾功能、脂代谢、炎症因子、IR、CAC、并发症、转归情况及卫生经济学效益。对患者随访3年,根据转归情况将其分为生存组(n=130)和死亡组(n=75),比较2组临床资料,分析影响患者预后生存的相关因素。结果治疗后,2组Scr(血肌酐)、BUN(血尿素氮)、(UAE)、UAER(尿蛋白排泄量)、TC(总胆固醇)、TG(甘油三脂)、LDL-C(低密度脂蛋白胆固醇)较治疗前显著降低[对照组:Scr(μmol/L)349.62±37.16 vs 201.73±24.58,BUN(mmol/L)28.43±5.39 vs20.81±3.47,UAER(μg/min)60.14±11.52 vs 55.73±9.86,TC(mmol/L)5.46±0.93 vs 4.75±0.69,TG(mmol/L)2.58±0.64 vs 2.13±0.57,LDL-C(mmol/L)3.69±0.73 vs2.45±0.60;观察组:Scr(μmol/L)352.14±38.29 vs 136.85±16.47,BUN(mmol/L)27.96±5.25 vs17.56±3.68,UAER(μg/min)60.32±12.07 vs 49.85±7.42,TC(mmol/L)5.48±0.97 vs 4.27±0.56,TG(mmol/L)2.55±0.62 vs 1.49±0.35,LDL-C(mmol/L)3.72±0.74 vs1.91±0.48],eGFR(肾小球滤过率)和HDL-C(高密度脂蛋白胆固醇)较治疗前显著升高[对照组:eGFR(mL/min/1.73m)29.32±3.25 vs 72.54±7.86,HDL-C(mmol/L)1.13±0.24 vs1.28±0.31,观察组:eGFR(mL/min/1.73m)30.05±3.29 vs121.63±13.34,HDL-C(mmol/L)1.09±0.22 vs 1.57±0.46],P<0.05;2组FBG(空腹血糖)、FINS(空腹胰岛素)、HOMA-IR(胰岛素抵抗指数)、IL-6(白介素-6)、IL-8(白介素-8)、TNF-α(肿瘤坏死因子-α)及hs-CRP(超敏C反应蛋白)均较治疗前显著降低[对照组:FBG(mmol/L)4.99±0.95 vs 4.52±0.63,FINS(mU/L)12.93±2.54 vs10.15±2.21,HOMA-IR 2.87±0.54 vs 2.04±0.43,IL-6(pg/
