血液透析患者血管钙化相关因素分析及防治策略

Analyses of related factors and prevention strategy for vascular calcification in hemodialysis patients

慢性肾脏病终末期患者最终的结局是维持性透析,由于自身的条件不同,有些人选择了血液透析(Hemodialysis,HD),有些人选择了腹膜透析。HD患者发生血管钙化的因素较多,既有传统的因素,如:血脂异常、高血压、糖尿病等,也有非传统的因素,如成纤维细胞生长因子23(fibroblast growth factor23,FGF23)水平、血清klotho水平、细胞外的晚期糖基化终末产物受体(Receptor for advanced glycation end products,RAGE)结合蛋白S100A12(en-rage)、血清可溶性肿瘤坏死因子样凋亡微弱诱导剂(Serum soluble tumor necrosis factor like weak inducer of apoptosis,STWEAK)水平、血清胎球蛋白A(Serum immunoglobulin A,fetuin-A)水平等。本综述进一步阐述哪些因素参与了HD患者的血管钙化,同时针对这些因素明确了降低透析患者血管钙化风险的一些策略。

The final treatment step for chronic kidney disease patients is maintenance dialysis. The selec- tion of hemodialysis （HD） or peritoneal dialysis （PD） is based on conditions of the patients. HD patients have more factors for vascular calcification. The traditional factors include dyslipidemia, hypertension and diabe- tes. The nontraditional factors include the serum levels of FGF-23, Klotho, the extracellular end product recep- tor for advanced glycation end products （RAGE） binding protein S100A12 （EN-RAGE）, serum soluble tumor necrosis factor like weak inducer of apoptosis （STWEAK）, and fetuin A. This review further describes the fac- tors involved in vascular calcification in hemodialysis patients and the strategies to reduce the risk of vascular calcification in dialysis patients.