nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2010-14-3-37-45nefr-1228Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSРЕНТГЕНОЛОГИЧЕСКАЯ ОЦЕНКА КАЛЬЦИФИКАЦИИ БРЮШНОЙ АОРТЫ У БОЛЬНЫХ С ХРОНИЧЕСКОЙ БОЛЕЗНЬЮ ПОЧЕК, ПОЛУЧАЮЩИХ ГЕМОДИАЛИЗ: ЧАСТОТА ВЫЯВЛЕНИЯ И АССОЦИИРОВАННЫЕ ФАКТОРЫRADIOLOGICAL ASSESSMENT OF ABDOMINAL AORTIC CALCIFICATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE RECEIVING HEMODIALYSIS: THE FREQUENCY OF DETECTION AND ASSOCIATED FACTORSВолковМ. М.VolkovM. M.

Кафедра пропедевтики внутренних болезней.

197022, Санкт-Петербург, ул. Л.Толстого, д. 17, СПбГМУ им. акад. И.П. Павлова, Нефрокорпус, тел.: (812)-234-91-94.

vmm58@mail.ruСмирновА. В.SmirnovA. V.

Кафедра пропедевтики внутренних болезней,

Научно-исследовательский институт нефрологии.

Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаRussian Federation2010100320101433745Copyright © Волков М.М., Смирнов А.В., 20102010Волков М.М., Смирнов А.В.Volkov M.M., Smirnov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1228

ЦЕЛЬ ИССЛЕДОВАНИЯ. Определить частоту кальциноза брюшной аорты (КБА) и факторы, с ним связанные, у пациентов, получающих хронический гемодиализ (ГД). ПАЦИЕНТЫ И МЕТОДЫ. У 65 пациентов (М/Ж –34/31), 52,3±11,8 года, получавших лечение ГД в среднем 77,1±76,8 мес, помимо обычных клинико-лабораторных показателей, были определены С-реактивный белок (СРБ), интактный паратиреоидный гормон (ПТГ), липидограмма, толщина комплекса интима–медиа сонных артерий (КИМ), выполнены мониторирование ЭКГ и АД, стандартная эхокардиография, определены минеральная плотность костей предплечья (МПК), выраженность КБА рентгенологически, а также длительность терапии активной формой витамина D (альфакальцидолом). РЕЗУЛЬТАТЫ. КБА обнаружен у 58,5% обследованных и, по данным корреляционного анализа, был значительнее у пациентов с: большей длительностью ГД, более высокими значениями кальция крови, ПТГ, СРБ, меньшим индексом массы тела (ИМТ), низкой МПК, большей толщиной КИМ, наличием ишемии миокарда при кардиомониторировании, более частой желудочковой экстрасистолией, а также более значительными диаметром и толщиной стенки правого желудочка, относительной толщиной стенки левого желудочка, давлением в легочной артерии. По данным многофакторных методов, КБА чаще встречался у лиц с длительным ГД и меньшей продолжительностью терапии альфакальцидолом. ЗАКЛЮЧЕНИЕ. КБА был выявлен у 58,5% пациентов, находящихся на ГД, и связан с нарушениями фосфорно-кальциевого обмена, гиперпаратиреозом, негативными изменениями внутрисердечной гемодинамики. Впервые обнаружена обратная зависимость тяжести КБА с МПК предплечья и с длительностью терапия альфакальцидолом.

THE AIM. To determine the frequency of abdominal aorta calcification (AAC) and the associated factors in patients on chronic hemodialysis (HD). Patients and Methods. In 65 patients (male / female -34/31), 52,3 ± 11,8 years, treated with HD in average 77,1 ± 76,8 months, in addition to conventional clinical and laboratory parameters there were determined C-reactive protein (CRP), intact parathyroid hormone (PTH), lipid profile, the thickness of the intima-media of carotid arteries (IMT). Monitoring of ECGand blood pressure, standard echocardiography, forearm bone mineral density (BMD), X-ray evaluation of AAC severity were made. Duration of therapy with active form of vitamin D (alfacalcidol) was evaluated. RESULTS. AAC was found in 58.5% of the patients. Correlation analysis showed that AAC was more significant in patients with: greater duration of HD, higher levels of blood calcium, PTH, CRP, lower body mass index (BMI), low BMD, thicker IMT, myocardial ischemia, frequent ventricular premature beats at ECG monitoring, large diameter and wall thickness of the right ventricle, thick wall of the left ventricle, high pulmonary artery pressure. According to multivariate methods AAC was more common in people with long duration of HD and a shorter duration of alfacalcidol therapy. CONCLUSION. AAC was detected in 58,5% of patients on HD and was associated with disorders of phosphorus-calcium metabolism, hyperparathyroidism, adverse changes of intracardiac hemodynamics. For the first time there was found an inverse relationship of severity of AAC with forearm BMD of the duration of alfacalcidol therapy.

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The authors declare that there are no conflicts of interest present.