doktorska disertacija
Silva Breznik (Author), Breda Pečovnik-Balon (Mentor), Breda Pečovnik-Balon (Thesis defence commission member), Vojko Flis (Thesis defence commission member), Katarina Šurlan Popović (Thesis defence commission member), Mitja Rupreht (Thesis defence commission member), Pavel Skok (Thesis defence commission member), Robert Ekart (Co-mentor), Tomaž Šeruga (Co-mentor)

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;žilne kalcifikacije;stranski rentgenogram;Bolezni krvožilja;Srčne arterije;Zapleti;Pretok krvi;Stene žil;Kalcifikacije v žilah;Bolezni izločal;Kronična ledvična odpoved;

Data

Language: Slovenian
Year of publishing:
Typology: 2.08 - Doctoral Dissertation
Organization: UM - University of Maribor
Publisher: S. Breznik]
UDC: 616.61-008.6:616.13-004.6(043.3)
COBISS: 6088255 Link will open in a new window
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Secondary language: English
Secondary title: RADIOGRAPHIC ASSESSMENT OF ARTERIAL CALCIFICATION IN PATIENTS ON CHRONIC HEMODIALYSIS
Secondary 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.
Secondary keywords: Kidney failure, chronic;Kronična ledvična odpoved;Coronary artery disease;Bolezen koronarnih arterij;Ankle brachial index;Gleženjski indeks;Fibroblast growth factors;Fibroblastni rastni dejavniki;Blood flow velocity;Hitrost pretoka krvi;
URN: URN:SI:UM:
Type (COBISS): Dissertation
Thesis comment: Univ. v Mariboru, Medicinska fak.
Pages: 87 str.
ID: 9149614