血液透析患者超敏C-反应蛋白水平与心室结构和功能的相关研究  

Serum high sensitive C-reactive protein level correlates with cardiac structure and function in patients maintained on hemodialysis

作　　者：马瑞霞[1] 周海燕[1] 徐岩[1] 刘丽秋[1] 

机构地区：[1]青岛大学医学院附属医院肾内科,山东青岛266003

出　　处：《临床内科杂志》2007年第4期244-246,共3页Journal of Clinical Internal Medicine

摘　　要：目的探讨维持性血液透析(MHD)患者超敏C-反应蛋白(hs-CRP)水平与心室结构和功能改变之间的关系。方法选择在我院血液透析中心治疗的MHD患者60例,所有患者均稳定透析3个月以上,以免疫透射比浊法分别测定其透析前空腹hs-CRP2次,2次时间间隔3周,同时测定所有患者透析前血红蛋白(Hb)、血清白蛋白(A lb)、总白蛋白(PA)、甘油三酯(TG)及总胆固醇(T-Ch)、纤维蛋白原和肌钙蛋白T(TnT)等。用二维彩色超声心动图测定心脏左心房前后径(LAD)、室间隔厚度(IVST)、左室前后径(LVD)、左室重量指数(LVM I)及左室射血分数(LVEF)。根据hs-CRP水平分为升高组(hs-CRP≥3 mg/L)及正常组(hs-CRP<3 mg/L),分别观察hs-CRP与心室结构、功能及血生化指标之间的关系。结果升高组较正常组透析剂量低(P<0.01)。纤维蛋白原和TnT明显高于正常组(P均<0.01)。心脏超声检查发现升高组心室结构指标LAD、IVST、LVD、LVM I均大于正常组(P<0.05);而LVEF低于正常组(P<0.05)。血超敏C-反应蛋白水平与纤维蛋白原和TnT呈正相关(r=0.376,0.285,P<0.01,P<0.05);与IVST、LVD、LVIM呈正相关(r=0.317,r=0.312,r=0.307,P值均<0.05),而与LVEF呈显著负相关(r=-0.386,P<0.01)。结论持续增高的hs-CRP是心脏结构功能变化的独立危险因素,并可预示维持性血液透析患者的左室肥厚和功能障碍。Objective To investigate serum high sensitive C-reactive protein（hs-CRP） level and its correlation with the cardiac structure and function in patients maintained on hemodialysis. Methods Predialysis hs-CRP was measured twice at interval of 3 weeks in 60 stable hemodialysis patients. The serum levels of hs-CRP, hemoglobin, albumin, total protein, triglyceride, cholesterol, fibrinogen, troponin T were determined, and echocardiographic studies were performed. The patients were divided into elevated hs-CRP group（ hs-CRP ≥ 3mg/L） and normal hs-CRP group （hs-CRP 〈 3mL）. The association between hs-CRP and cardiac structure and function were analyzed respectively. Results Patients with high CRP had a lower dialysis dose （ P 〈 0.01 ）, higher troponin T（ P 〈 0.01 ）, and higher fibrinogen （ P 〈 0.01 ）. Echocardiographic studies showed that left atrial diameter （LAD）, interventricular septal thickness （IVST） ,left ventricular diameter （LVD） ,and left ventricular mass index（LVMI） were higher in patients with high CRP （ all P 〈 0.05 ）. However the left ventricular ejection fraction （LVEF） was lower in patients with high CRP （ P 〈 0.05 ）. There were negative relationship between hs-CRP and LVEF and positive relationship between hs-CRP and serum troponin T and fibrinogen （ r = 0. 376,0.285, P 〈 0.01, P 〈 0.05 ）, and LAD,LVD,LVIM （r=0. 376,0.285,P 〈0.01,P 〈0.05,all P 〈0.05）. Condusion Persistent elevation of CRP may predict cardiac hypertrophy and dysfunction in patients maintained on hemodialysis.

关 键 词：C-反应蛋白 血液透析 左室肥厚 心脏功能障碍 

分 类 号：R692.5[医药卫生—泌尿科学]