血浆同型半胱氨酸水平、颈动脉内膜中层厚度与内瘘闭塞的关系  

The correlation of plasma total homocysteine concentration and intima-medial thickness of extracranial common carotid artery to the arterial-venous fistulae thrombosis in maintenance hemodialysis patients

作　　者：易扬[1] 路建饶[1] 田军[2] 姚洁洁[3] 陆文娟[3] 武立群[1] 顾波[1] 王汉清[1] 张金元[4] 

机构地区：[1]上海市静安区中心医院肾内科,上海200040 [2]解放军第455医院肾内科,上海200030 [3]上海市静安区中心医院B超室,上海200040 [4]上海市静安区中心医院 B 超室,上海200040

出　　处：《中国血液净化》2008年第5期263-265,共3页Chinese Journal of Blood Purification

摘　　要：目的探讨维持性血液透析(MHD)患者血浆总同型半胱氨酸(tHcy)浓度与颈动脉内膜中层厚度(IMT)之间的相关性及其在动静脉内瘘栓塞发生中的作用。方法选择上海市静安中心医院和解放军第455医院MHD患者120例,根据其在半年内是否有过1次或1次以上的动静脉内瘘栓塞事件,将其分为动静脉内瘘栓塞组(AVFT)和动静脉内瘘非栓塞组(NAVFT),所有患者采用Phllips Iu22彩色多普勒超声仪测量IMT,于透析日抽空腹血测定血浆tHcy、叶酸(FA)、VitB_(12)、肌酐(Scr)、尿素氮(Bun)、血糖(glu)、血浆白蛋白(Alb)、胆固醇(Ch)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)。结果MHD患者高同型半胱氨酸血症(HHcy)发生率为90%,是正常人的34.6倍,其血浆tHcy水平(27.6±8.3)μmol/L明显高于正常对照组(7.5±1.7)μmol/L,P<0.01。AVFT组tHcy血浆浓度、IMT平均值明显高于NAVFT组,P<0.01,tHcy>40umol/L的患者数也明显多于NAVFT组,P<0.05;MHD患者血浆tHcy浓度与IMT呈明显正相关,r=0.362,P<0.01。结论MHD患者普遍存在HHcy,HHcy可能是动静脉内瘘栓塞的重要原因之一。Objective To evaluate the relationship between plasma total homocysteine concentration （tHcy） and intima-medial thickness of extracranial common carotid artery （IMT）, and their roles in arterial-venous fistulae thrombosis in maintenance hemodialysis （MHD） patients. Methods Based on the presence of arterialvenous fistulae thrombosis within 6 months, we assigned 120 MHD patients into arterial-venous fistulae thrombosis group （AVFT） or non-arterial-venous fistulae thrombosis group （NAVFT）. IMT measurement using Phillips Iu22 Doppler Ultrasonics, and blood chemistry including plasma tHcy were assayed in all patients. Results In MHD patients, the frequency of hyperhomocysteinmia was 90%, which is 34.6 times higher than that in normal individuals （P 〈0.01）. Plasma tHcy and the average IMT value were higher in AVFT group than in NAVFT group （P 〈0.01）. The number of patients with plasma tHcy 〉40umol/L was more in AVFT group than in NAVFT group （P 〈0.05）. Linear regression analysis showed a significant positive correlation between plasma tHcy and IMT （r =0.362, P 〈0.01）. Conclusions Hyperhomocysteinmia presents frequently in MHD patients, and may be a risk factor for arterial-venous fistulae thrombosis in these patients.

关 键 词：血液透析 同型半胱氨酸 颈动脉内膜中层厚度 动静脉内瘘栓塞 

分 类 号：R692.5[医药卫生—泌尿科学] R54[医药卫生—外科学]