透析は,部分的には,滑らかな筋肉細胞のアポプトシスを誘発することによって,中枢血管の化を加速します
Rukshana C Shroff1, Rosamund McNair, Nichola Figg
1Nephrology Unit, Great Ormond Street Hospital, University College London Institute of Child Health, King's College London, London SE5 9NU.
Circulation
|October 8, 2008
まとめ
血管加熱は透析前に始まりますが,透析中の血管滑らかな筋肉細胞 (VSMC) のアポトーシスは,明白な加熱と損傷を誘発します. VSMCの死亡の原因となる要因を特定することは,予防の鍵です.
科学分野:
- ネフロロジーはネフロロジーを用います.
- 血管生物学 血管生物学
- 小児医学は,小児科の医学である.
背景:
- 血管カルシフィケーションは,ステージVの慢性腎臓病 (CKD) の罹病率と死亡率の重要な危険因子です.
- 小児性CKDにおける血管カルシフィケーションの初期病原性とインビヴォ発起メカニズムは,まだ十分に理解されていない.
研究 の 目的:
- ステージVCKD (前透析および透析) の小児における動脈カルシウム (Ca) 負荷を定量化するために.
- 臨床的,生化学的,および血管に関する測定値とCa負荷を相関させる.
- 小児CKDにおける血管カルシフィケーションの基礎となるメカニズムを解明する.
主な方法:
- 透析前および透析中の小児CKD患者からの動脈組織サンプルをカルシウム含有量について分析した.
- 血清カルシウムおよびリン酸製品を含む臨床的および生化学的データが収集されました.
- 頸動脈内側介質の厚さ,大動脈の硬さなどの血管に関する測定値が評価されました.
- ヒスト学的検査,特定のマーカー (アルカリリンフォスファターゼ,Runx2,オステリックス,アネクシンVI) に対する免疫ヒスト化学,電子顕微鏡を用いて,血管滑らかな筋肉細胞 (VSMC) のアポトーシス,骨質変異,および化開始を評価した.
主要な成果:
- 高血圧カルシウム (Ca) 負荷は,前透析患者および透析患者の両方において観察され,血清カルシウム × リン酸製品と相関していました.
- 透析患者では,頸動脈内膜の厚みと大動脈の硬さが増加した.
- 組織学的分析により,直前透析器は完ぺきで,透析器はアポトーシスによる血管性滑らかな筋肉細胞 (VSMC) の損失が顕著であった.
- 透析容器は,アルカリリンフォスファタゼの活性とRunx2とオステリクスの発現の増加を示し,VSMCの骨質変異を示した.
- 膀マーカーとミネラライゼーション阻害剤は透析器に増加し,明らかな化が先行した.
- 電子顕微鏡では,損傷したVSMCの膀内のヒドロキシアパタイトナノ結晶を特定し,カルシフィケーションを開始する役割を示唆しました.
結論:
- 動脈カルシウムの蓄積は,小児性CKDの分析前の段階で始まります.
- 透析中の血管滑らかな筋肉細胞 (VSMC) アポプトシスは,防衛機構を損なう重要なイベントであり,露骨な化につながる.
- このVSMCのアポプトシスは,最終的に臨床的に検出可能な血管損傷をもたらします.
- 透析中の患者のVSMC死亡を誘発する要因を特定することは,血管カルシフィケーションとその合併症を予防するために重要です.
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