慢性肾脏病患者冠状动脉微循环功能障碍相关研究进展

Coronary microvascular dysfunction in chronic kidney disease

冠状动脉微循环障碍(CMD)是一种在无阻塞性冠心病的情况下出现心绞痛、心电图为缺血性改变的临床综合征,主要病理生理机制表现为结构性、功能性改变以及血管外的改变。可通过正电子发射断层成像(PET)等无创手段和带有传感器的血管导管等有创手段评估及诊断CMD。慢性肾脏病患者中高血压、蛋白尿、尿毒症毒素、贫血、矿物质代谢障碍和慢性炎症状态通过一系列特殊机制导致冠状动脉微血管不良重塑与内皮功能障碍,从而引起CMD。

Coronary microvascular dysfunction is a clinical syndrome in which angina pectoris occurs without obstructive coronary heart disease and the electrocardiogram shows ischemic changes.The main pathophysiological mechanisms are structural,functional and extravascular changes.Coronary microvascular dysfunction can be assessed and diagnosed by non⁃invasive methods such as positron emission tomography and invasive methods such as vascular catheters with special sensors.In chronic kidney disease patients,hypertension,proteinuria,uremic toxins,anemia,mineral metabolism disorders,and chronic inflammation state lead to coronary microvascular remodeling and endothelial dysfunction through a series of special mechanisms,thereby causing coronary microvascular disfunction.