作者：Laurie Barclay, MD
出處：WebMD醫學新聞
November 26, 2008 — 根據登載於11月5日美國腎臟學會期刊中的研究報告，高血磷值的年輕健康成人，其冠狀動脈鈣值比較可能增加。
明尼蘇達大學、美國腎臟資料系統、心血管特殊研究中心的Robert N. Foley寫道，動物實驗與末期慢性腎臟病的人類研究皆顯示，磷值與粥狀動脈硬化有關，但是對於腎功能正常者是否也有此一關係則不清楚。本研究目標在確認磷值和冠狀動脈鈣值之間是否有關聯，研究對象是社區基礎的3015名健康年輕成人，屬於前溯式「年輕成人的冠狀動脈發生風險(Coronary Artery Risk Development in Young Adults,CARDIA)」研究。
參與者接受基礎磷值測量，且在15年後以電腦斷層評估冠狀動脈鈣值；研究開始時，平均年紀為25.2歲，平均磷值為3.6 mg/dL，平均鈣值為9.5 mg/dL；只有0.2% 參與者的估計腎絲球過濾速率小於60 mL/min每1.73 m2 。
在未校正模式中，磷值與冠狀動脈鈣值有關，在多變項模式中，磷值與冠狀動脈鈣值程度有顯著關係。
研究限制包括非實驗式設計，無法確認磷值和冠狀鈣化之間的關係是否為真，或者是殘餘共同發現現象；無法確認基因和環境因素的相關影響；缺乏甲狀腺荷爾蒙與維他命D資料；樣本數有限，有些研究樣本經過挑選。
研究作者寫道，較高的血清磷值，即使在正常範圍內，也可能是健康年輕成人冠狀動脈粥狀硬化的風險因素。除了基本決定因素之外，研究中發現的關聯認為，高磷值也許有助於辨識那些具有可調控風險的年輕成人，可以更積極篩檢和處置。
國家糖尿病與消化和腎臟病研究中心、國家健康研究中心資助本研究。作者中有3人與Amgen和/或Genzyme有各種的財經關係。
J Am Soc Nephrol. 線上登載於2008年11月5日。
Higher Blood Phosphorus Levels May Predict Increased Calcium Levels in Coronary Arteries
By Laurie Barclay, MD
Medscape Medical News
November 26, 2008 — Young healthy adults with higher levels of phosphorus in the blood are more likely to have increased levels of calcium in the coronary arteries, according to the results of a study reported in the November 5 issue of the Journal of the American Society of Nephrology.
“Phosphorus levels correlate with atherosclerosis in both animal models and humans with advanced chronic kidney disease, but whether this relationship exists among individuals with normal kidney function is unknown,” write Robert N. Foley, from the Cardiovascular Special Studies Center, United States Renal Data System, and the University of Minnesota in Minneapolis, and colleagues. “This study aimed to determine whether an association exists between phosphorus levels and coronary artery calcium levels in a community-based cohort of 3015 healthy young adults in the prospective Coronary Artery Risk Development in Young Adults (CARDIA) study.”
Participants underwent baseline measurement of phosphorus levels and computed tomography 15 years later to evaluate the presence of coronary artery calcium. At study entry, mean age was 25.2 years; mean phosphorus level was 3.6 mg/dL, and mean calcium level was 9.5 mg/dL. Estimated glomerular filtration rate was less than 60 mL/min per 1.73 m2 in only 0.2% of participants.
In unadjusted models, phosphorus levels were associated with coronary artery calcium, and in multivariate models, phosphorus levels were significantly associated with the category of coronary artery calcium level.
Study limitations include nonexperimental design preventing determination of whether the association between phosphorus levels and coronary calcification is a true phenomenon or of the magnitude of residual confounding; inability to determine the relative contributions of genetic and environmental factors to the associations; lack of data on parathyroid hormone and vitamin D levels; limited sample size; and somewhat self-selected study sample.
“Higher serum phosphorus levels, even within the normal range, may be a risk factor for coronary artery atherosclerosis in healthy young adults,” the study authors write. “Quite apart from the underlying determinants, the associations seen in this study suggest that high phosphorus levels might help to identify young adults for whom modifiable risk factors might be screened and managed more aggressively.”
The National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, funded this study. Three of the authors report various financial arrangements with Amgen and/or Genzyme.
J Am Soc Nephrol. Published online November 5, 2008.
[ 本帖最後由 goodcat1111 於 2008-12-15 11:45 編輯 ] |
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