慢性肾脏病患者血浆肾上腺髓质素水平与心室重构关系研究  

Relationship between level of plasma adrenomedullin and ventricular remodeling in patients with chronic kidney disease

作　　者：巴图[1] 甄怀蒙[1] 张红颖[1] 苏华科[1] 

机构地区：[1]解放军第253医院心内科,呼和浩特010051

出　　处：《中国循证心血管医学杂志》2013年第5期492-494,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的：观察慢性肾脏病（CKD）患者血浆肾上腺髓质素（adrenomedullin，ADM）的变化，探讨血浆ADM水平与心室重构的关系。方法纳入2009年1月~2010年7月解放军第253医院CKD患者60例，其中32例患者为CKD5期（A组），28例患者为CKD3期（B组）；同期纳入60例体检肾功能正常者作为对照组（C组）。采用放射免疫法测定各组血浆ADM水平，同时应用ATL公司HDI-5000型彩色多普勒超声诊断仪测定心功能指标，包括左室舒张末内径（LVDd）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、左心室射血分数（LVEF）、舒张早期和晚期最大血流速度比（E/A），计算左心室重量指数（LVMI），采用直线相关及多元回归法对ADM和各项心功能指标进行相关分析。结果 A组血浆ADM水平最高[（35.22±28.22）pg/ml]，其次为B组[（10.60±4.41）pg/ml]，C组最低[（8.71±2.55）pg/ml]，三组间两两存在统计学差异（P＜0.05）；A组、B组和C组LVDd、IVST、LVPWT和LVMI依次降低， LVEF和E/A值依次升高，A组和B组均与C组存在统计学差异，但A组与B组之间无统计学差异。血浆ADM与LVDd、IVST、LVPWT、LVMI呈正相关，与LVEF和E/A值呈负相关。在剔除了性别、年龄、血压、血脂、血红蛋白等因素后，血浆ADM仍是LVPWT、LVDd、E/A的独立影响因素（P分别为0.014、0.035、0.05）。结论CKD患者血浆ADM水平显著升高，高ADM水平是CKD患者心室重构的独立危险因素之一。Objective To observe the changes of plasma adrenomedullin （ADM） and discuss the relationship between ADM and ventricular remodeling in the patients with chronic kidney disease （CKD）. Methods The CKD patients （n=60） were chosen from the 253rd Hospital of Chinese PLA from Jan. 2009 to Jul. 2010, and divided into group A （with stage 5 CKD, n=32） and group B （with stage 3 CKD, n=28）. At the same time 60 cases with normal renal function were chosen as group C （control group）. The level of plasma ADM was detected by using radioimmunoassay. The cardiac function indexes, including LVDd, IVST, LVPWT, LVEF and E/A were determined by applying color Doppler ultrasonic diagnostic apparatus. LVMI was calculated. The correlation between ADM and cardiac function indexes were analyzed by using the methods of linear correlation and multiple regression. Results The level of ADM was the highest [（35.22±28.22） pg/mL] in group A, followed by group B [（10.60±4.41） pg/mL] and the lowest in group C [（8.71±2.55） pg/mL], and the pairwise comparison among three groups showed statistical difference （P〈0.05）. LVDd, IVST, LVPWT and LVMI decreased and LVEF and E/A increased in order in group A, group B and group C, and there was statistical difference between group A or group B and group C, but no statistical difference between group A and group B. ADM was positively correlated to LVDd, IVST, LVPWT and LVMI, and negatively correlated to LVEF and E/A. After excluding the factors of sex, age, blood pressure, blood fat and hemoglobin, ADM still was the independent influence factor of LVPWT, LVDd and E/A （P=0.014, P=0.035, P=0.05）. Conclusion The level of ADM increases significantly in CKD patients, which is one of independent risk factors of ventricular remodeling.

关 键 词：慢性肾脏病 肾上腺髓质素 心室重构 

分 类 号：R692[医药卫生—泌尿科学]