慢性肾脏病患者血清游离脂肪酸与心脏结构和功能的关系  

Relationship Between Serum Level of Free Fatty Acid and Cardiovascular Disease in Chronic Kidney Disease Patients

作　　者：邬碧波[1] 张黎明[1] 唐琦[1] 俞勇[1] 贺云岚[1] 

机构地区：[1]上海市闸北区中心医院肾内科,上海200070

出　　处：《中国中西医结合肾病杂志》2011年第1期43-46,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：上海市卫生局科技发展基金资助项目(No.2009255;2007Y71);上海市闸北区卫生局科研基金资助项目(No.2009ZBMXK02);上海市闸北区中心医院"789攀登计划"基金资助项目

摘　　要：目的:研究慢性肾脏病(CKD)患者不同时期血清游离脂肪酸(FFA)和高敏C反应蛋白(hs-CRP)水平的变化及与心脏结构和功能的关系。方法:对188例CKD患者(非透析治疗130例,血液透析58例)的临床及实验室资料作回顾性研究,应用酶比色法检测血清FFA、免疫比浊法检测hs-CRP,并应用心脏超声心动图测定患者的心脏结构和功能,分析FFA水平的变化与心脏结构和功能的关系。结果:CKD患者无论透析与否,FFA水平较健康对照组显著升高[(492.63±143.59)vs(302.65±142.18)μmol/L,P<0.01],hs-CRP水平较健康对照组显著升高[(8.11±3.85)vs(4.63±1.34)mg/L,P<0.01],在非透析CKD患者中,随着肾功能的逐渐减退,血FFA和hs-CRP水平也逐渐升高,各组间比较差异有统计学意义(P<0.05或P<0.01),且HD组FFA和hs-CRP水平较非透析CKD各组更高(P<0.05);直线相关分析显示,血FFA水平与hs-CRP、左心室心肌重量指数(LVMI)、心脏功能综合指数(Tei指数)、TG呈正相关(P<0.05,P<0.01),与LVEF、GFR呈负相关(P<0.05);多因素逐步回归分析显示,FFA、hs-CRP和年龄是CKD患者心脏结构和功能异常的危险因素。结论:大约50%CKD患者FFA水平明显升高,且与hs-CRP及心脏结构和功能异常相关,提示高游离脂肪酸血症是CKD患者并发心血管疾病的危险因素之一。Objective：To investigate the serum level of free fatty acid（FFA）and explore its relationship with cardiovascular disease（CVD）in patients with chronic kidney disease（CKD）.Methods：The serum level of FFA was determined by enzymatic colorimetry,high-sensitivity C-reactive protein（hs-CRP）was measured by immunoturbidimetry.Prevalence of CVD was detected by echocardiography.We evaluated the relationship between serum levels of FFA and hs-CRP as well as the renal function in 130 adult patients with CKD,stratified according to the glomerular filtration rate（GFR）（based on the National Kidney Foundation/Kidney Dialysis Outcomes Quality Initiatives）and also in 58 hemodialysis（HD）patients.The relationship between FFA level and CVD incidence in CKD patients was analyzed by Logistic regression model.Results：The serum levels of FFA and hs-CRP were significantly higher in CKD patients compared to the health controls[（492.63±143.59）vs（302.65±142.18）μmol/L,（8.11±3.85）vs（4.63±1.34）mg/L,P0.01],even in those patients in early stage of CKD.The level of FFA increased with the progression of renal dysfunction.In the non-dialytic CKD group,the level of FFA was negatively related to GFR and positively related to the proteinuria respectively（P0.05）,while in the HD group,it was positively correlated with dialysis duration（P0.05）.The serum levels of FFA were higher in CKD patients with CVD than those in patients without（P0.05）.The prevalence left ventricular hypertrophy（LVH）in HD and CKD5 patients was significantly higher than that in healthy controls（P0.05 or P0.01）.Left ventricular mass index（LMVI）and myocardial performance index（Tei index）in HD and CKD 5 patients increased significantly（P0.05 or P0.01）.Also these parameters in HD group were remarkably higher than those in non-dialytic CKD 5 patients（P0.05）.In all patients,FFA was positively correlated with LMVI,Tei index,hs-CRP,and TG,whereas was negatively correlated with left ventricular ejection f

关 键 词：慢性肾衰竭 心血管疾病 游离脂肪酸 C反应蛋白 

分 类 号：R692[医药卫生—泌尿科学]