Rentgenska ocena arterijskih kacifikacij pri bolnikih, zdravljenih s kronično hemodializo

Breznik, Silva

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Title:	Rentgenska ocena arterijskih kacifikacij pri bolnikih, zdravljenih s kronično hemodializo
Authors:	ID Breznik, Silva (Author) ID Šeruga, Tomaž (Mentor) More about this mentor... ID Pečovnik Balon, Breda (Mentor) More about this mentor... ID Ekart, Robert (Comentor)
Files:	DOK_Breznik_Silva_2017.pdf (1014,28 KB) MD5: EA260B6C811ECF96359EF960D0ED8798
Language:	Slovenian
Work type:	Doctoral dissertation
Organization:	MF - Faculty of Medicine
Abstract:	Uvod Žilne kalcifikacije so pri bolnikih s kronično ledvično boleznijo (KLB) eden najpomembnejših dejavnikov tveganja za povečano srčno-žilno umrljivost in obolevnost. Predstavljajo odziv na motnjo metabolizma serumskega kalcija in fosfata. Celoten sklop motenj zajema uveljavljena kratica KLB - MKB (kronična ledvična bolezen – mineralna in kostna bolezen), ki kot posledica motnje metabolizma mineralov in kosti vodi v kostno diferenciacijo gladkomišičnih celic ter nastanek žilnih kalcifikacij v tuniki mediji (srednji mišični plasti arterij). Prisotnost žilnih kalcifikacij lahko ugotavljamo z različnimi metodami. Bolniki in metode V raziskavo smo vključili 102 bolnika, zdravljena s kronično hemodializo, od teh je bilo 60 (58,8 %) moških, srednja starost bolnikov je bila 61,8 let (razpon 24-85 let). Povprečen čas hemodializnega zdravljenja je bil 52,3 meseca (razpon 1-208 mesecev). Ocena razsežnosti koronarnih kalcifikacij s pomočjo Agatstonove skale (CACS) je bila opravljena pri 28 bolnikih. Pri 102 bolnikih so bili opravljeni lateralni radiogram trebušne aorte za oceno kalcifikacij trebušne aorte (AACS), radiogram medenice in dlani za oceno kalcifikacij medeničnih arterij (SVCS medenica) in arterij rok (SVCS dlan) ter ultrazvok karotidnih arterij za oceno debeline intime-medije (IMT). Pri 93 bolnikih smo izmerili hitrost karotidno-femoralnega oziroma aortnega pulznega vala (PWV) ter pri 88 bolnikih gleženjski indeks (ABI). Določili smo tudi serumsko vrednost fibroblastnega rastnega faktorja-23 (FGF-23). Rezultati Ugotovili smo visoko prevalenco kalcifikacij. Koronarne kalcifikacije (CACS) smo našli pri 92 % (26 od 28) bolnikov. Z radiografsko oceno smo našli kalcifikacije pri 91,2 % bolnikov, od tega na lateralnem radiogramu pri 82,4 % (84 od 102), pri 76,5 % bolnikov na radiogramu medenice ter pri 55,9 % bolnikov na radiogramu rok. Zlati standard CACS je bil v pozitivni korelaciji z AACS (p<0,000, rho=0,665), SVCS medenice (p<0,000,rho=0,654), SVCS roke (p<0,007, rho=0,497) in s PWV (p<0,002, rho=0,594). Ugotovili smo tudi statistično značilno korelacijo med AACS in PWV (p<0,000, rho=0,442), SVCS medenice in PWV (p<0,000, rho=0,466) ter SVCS roke in PWV (p<0,000, rho=0,427). IMT je bila v pozitivni korelaciji z AACS (p<0,000, rho=0,590), s SVCS medenice (p<0,000, rho=0,401), s SVCS roke (p<0,005, rho=0,279) ter tudi s PWV (p<0,000, rho=0,533). Ugotovili smo negativno korelacijo med ABI in z AACS (p<0,002, rho=-0,321), s SVCS medenice (p<0,025, rho=-0,240), s SVCS roke (p<0,012, rho=-0,267) ter s PWV (p<0,006, rho=-0,300). FGF-23 ni bil statistično pomembno povezan z nobenim od preiskovanih parametrov kalcifikacij. Zaključek Naši rezultati so pokazali zelo dobro povezavo med enostavnimi metodami ugotavljanja srčno-žilnih kalcifikacij ter bolj kompleksnimi metodami, kot je CACS. Tako lahko zlati standard CACS nadomestimo s cenejšimi in enostavnejšimi metodami z manj rentgenskega sevanja kot sta AACS in SVCS. PWV, ABI in IMT so se pokazali kot prav tako dobri primerljivi označevalci ocene kalcifikacij v primerjavi s klasičnimi rentgenskimi metodami. FGF-23 ni bil povezan z drugimi preiskovanimi parametri.
Keywords:	debelina intime medije, fibroblastni rastni faktor, gleženjski indeks, hitrost aortnega pulznega vala, kronična ledvična bolezen, kalcifikacije koronarnih arterij, lateralni radiogram, rentgenska ocena žilnih kalcifikacij
Place of publishing:	Maribor
Year of publishing:	2017
PID:	20.500.12556/DKUM-60089
COBISS.SI-ID:	6088255
NUK URN:	URN:SI:UM:DK:Y64FQGRK
Publication date in DKUM:	17.08.2017
Views:	2200
Downloads:	137
Metadata:
Categories:	MF
:	BREZNIK, Silva, 2017, Rentgenska ocena arterijskih kacifikacij pri bolnikih, zdravljenih s kronično hemodializo [online]. Doctoral dissertation. Maribor. [Accessed 28 March 2025]. Retrieved from: https://dk.um.si/IzpisGradiva.php?lang=eng&id=60089 Copy citation

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Secondary language

Language:	English
Title:	RADIOGRAPHIC ASSESSMENT OF ARTERIAL CALCIFICATION IN PATIENTS ON CHRONIC HEMODIALYSIS
Abstract:	Introduction Vascular calcification is thought to be one of the most important risk factors for the increased cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD). They are thought to develop due to impaired metabolism of calcium and phosphorus. CKD-MBD (Chronic Kidney Disease – Mineral and Bone Disorders) states for many of different disturbances in mineral and bone metabolism, which lead to osteo/chondrocyte differentiation of smooth muscle cells and the development of vascular calcification in media of the vessel wall. The presence of vascular calcification can be established with different methods. Methods 102 chronic hemodialysis patients (60 men (58.8 %)), mean age 61.8 years (range 24 – 85 years) were enroled in the study. The mean duration of HD treatment had been 52.3 months (range 1-208 months). Coronary Artery Calcification Score (CACS) was performed in 28 patients. All 102 HD patients had Abdominal Aortic Calcification Score (AACS) from lateral lumbar radiograph and Simple Vascular Calcification Score (SVCS) from pelvic and hand radiograph. Vascular stiffness was assessed with Aortic Pulse Wave Velocity (PWV) in 93 patients, ankle-brachial index (ABI) in 88 patients and ultrasound assessment of Carotid Intima-Media Thickness (IMT) in 102 patients. Fibroblast Growth Factor-23 (FGF-23) was measured in 100 patients. Spearman's test was used for correlation between parameters. Results High prevalence of vascular calcification was found. 26 (92 %) of 28 patients had coronary artery calcification. 91.2 % of 102 patients had overall radiographically visible calcification. It was seen on lateral abdominal aorta radiograph in 82.4 %, 76.5 % on pelvis and 55.9 % on hand radiograph. A positive correlation was demonstrated between golden standard CACS and AACS (p <0.000, rho=0.665), CACS and SVCS pelvis (p<0.000,rho=0.654) and CACS and SVCS hand (p<0.007, rho=0,497). A positive Spearman's correlation was also found between CACS and PWV (p<0.002, rho=0.594), AACS and PWV (p<0.000, rho=0.442), SVCS pelvis and PWV (p<0.000, rho=0.466) and SVCS hand and PWV (p<0.000, rho=0.427). IMT correlated positively with AACS (p<0.000, rho=0.590), and SVCS pelvis (p<0.000, rho=0.401), and SVCS hand (p<0.005, rho=0.279) as well as with PWV (p<0.000, rho=0.533). Negative correlation was demonstrated between AACS and ABI (p<0.002, rho=-0.321), SVCS pelvis and ABI (p<0.025, rho=-0.240), SVCS hand and ABI (p<0.012, rho=-0.267) and PWV and ABI (p<0.006, rho=-0.300). We have not found statistically significant correlation between FGF-23 and any of the investigated parameters. Conclusion Our results showed a very good correlation of simple methods for cardiovascular calcification assessment to more complex and expensive method like CACS. Therefore, the golden standard CACS can be replaced with cheaper, simpler methods with less radiation like AACS and SVCS. PWV, ABI and IMT were found to be complementary markers of vascular calcification assessment to others classic radiographic methods. FGF-23 in our study did not show any correlation to other investigated parameters.
Keywords:	intima media thickness, fibroblast growth factor, ankle brachial index, pulse wave velocity, chronic kidney disease, coronary artery calcification, lateral lumbar radiograph, radiographic assessment of vascular calcification.

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