腹膜透析患者血浆二甲基精氨酸水平与左心功能的相关性研究  

Correlation research on plasma asymmetric dimethylarginine level and left ventricular function of peritoneal dialysis patient

作　　者：张德鱼 赵建荣 

机构地区：[1]内蒙古自治区人民医院肾内科,内蒙古呼和浩特010000

出　　处：《生物医学工程与临床》2015年第2期118-122,共5页Biomedical Engineering and Clinical Medicine

基　　金：内蒙古自治区高等学校科学技术研究项目(NJ10133);内蒙古自治区人才开发基金资助(No.2008)

摘　　要：目的研究腹膜透析患者血浆不对称二甲基精氨酸(ADMA)水平与左心功能的关系及腹膜透析对血浆ADMA水平的影响。方法选取内蒙古医科大学附属医院终末期肾脏病(ESRD,慢性肾功能不全尿毒症期)患者60例,同期健康志愿者30例(正常对照组),共计90例,其中男性54例,女性36例,平均年龄53.7岁。ESRD患者分持续性不卧床腹膜透析(CAPD,时间均大于3个月)治疗30例(CAPD治疗组)和保守治疗患者30例(保守治疗组)。3组年龄、性别相匹配。收集入组者的相关临床及实验室资料。使用酶联免疫吸附分析(ELISA)测定所有入组者血浆及CAPD治疗组患者腹膜透析液中ADMA含量;并对入组者行超声心动图检测,根据Devereux公式计算左心室质量(LVM)及左心室质量指数(LVMI)。统计学分析3组差异。结果 CAPD治疗组患者血浆ADMA水平为(0.125±0.076)μmol/L,保守治疗组血浆ADMA水平为(0.214±0.121)μmol/L,正常对照组血浆ADMA水平为(0.035±0.291)μmol/L,3组间差异有显著统计学意义(P=0.000)。CAPD治疗组血浆ADMA水平与左心室射血分数(LVEF)呈负相关(r=-0.562,P=0.001),且与LVMI、LVM、左心室舒张末期内径(LVDd)、左心房内径(LAD)呈正相关(P<0.05)。保守治疗组比CAPD治疗组患者LVMI高(P=0.01),且有左心室肥厚(LVH)的保守治疗组患者比有LVH的CAPD治疗组患者血浆ADMA水平高(P<0.05)。CAPD治疗组腹膜透析液ADMA水平为(0.146±0.077)μmol/L,CAPD治疗组腹膜透析液的ADMA水平与LVEF呈正相关(r=0.367,P=0.046),与LVMI呈负相关(r=-0.369,P=0.045)。结论 ESRD保守治疗组患者血浆ADMA水平与CAPD治疗组血浆ADMA水平均比正常对照组高,说明慢性ESRD存在ADMA的清除功能不全;CAPD治疗组血浆ADMA水平与LVH呈正相关,可以提示ADMA在CAPD患者左心室重构过程中可能起重要作用;保守治疗组比CAPD治疗组患者LVMI高,在腹膜透析液中检测到ADMA,说明腹膜透析可以在一定程度上清除血浆ADMA,腹膜透析对�Objective To study the relationship between the left cardiac function and the plasma asymmetric dimethylarginine（ADMA） level of continuous ambulatory peritoneal dialysis（CAPD） patients. Methods A total of 60 patients with end-stage renal disease（ESRD） were enrolled, and 30 healthy volunteers as normal control, included 54 males and 36 females with mean age of 53.7years old. The patients with uremia of chronic renal insufficiency were divided into 2 groups： CAPD group（n = 30, more than 3-month） and conservation treatment group（n = 30）. The age and gender among 3 groups were matched, the clinical materials and biochemical parameters were collected. The plasma ADMA level was tested by enzyme-linked immunosorbent assay（ELISA）.Echocardiography was performed on all the cases, and the left ventricular mass index（LVMI） and left ventricle mass（LVM） were calculated by Devereux formula. Statistical analysis was performed with SPSS13.0. Results The level of plasma ADMA in CAPD group, conservation treatment group and normal control group was（0.125 ± 0.076） μmol/L,（0.214 ± 0.121） μmol/L and（0.035 ±0.291） μmol/L, respectively, and the differences were significant among 3 groups（P = 0.000）. The level of plasma ADMA in CAPD patients was negatively correlated with left ventricular ejection fraction（LVEF）（r =- 0.562, P = 0.001）, and positively correlated with LVMI, LVM, left ventricular end-diastolic dimension（LVEDD）, and left atrial diameter（LAD）（P〈0.05）. Compared with CAPD group, the conservation treatment patients showed higher LVMI（P = 0.01）, and the plasma ADMA levels of CAPD patients with LVH were lower than that of conservation treatment patients with LVH（P〈0.05）. The ADMA level in peritoneal dialysis solution was（0.146 ± 0.077） μmol/L, and ADMA level of peritoneal dialysis solution in CAPD patients was negatively correlated with LVMI（r =- 0.369, P = 0.045）, but positively correlated with LVEF（r = 0.367, P = 0.046）. Conclusi

关 键 词：不对称二甲基精氨酸 持续不卧床腹膜透析 左心功能 终末期肾病 

分 类 号：R692.5[医药卫生—泌尿科学]