慢性肾衰竭患者同型半胱氨酸血症与动脉粥样硬化的关系  

The role of hyperhomocysteinemia on atherosclerosis in patients with chronic renal failure

作　　者：余月明[1] 侯凡凡[1] 周华[2] 杨燕[2] 张训[1] 杨凌 胡敏燕 

机构地区：[1]第一军医大学南方医院肾科,中国人民解放军肾脏病研究所,广州510515 [2]第一军医大学南方医院影像中心,广州510515 [3]第一军医大学南方医院临床药理实验室,广州510515

出　　处：《中华内科杂志》2002年第8期517-521,共5页Chinese Journal of Internal Medicine

摘　　要：目的　研究慢性肾功能衰竭 (CRF)患者血浆同型半胱氨酸 (Hcy)水平与动脉粥样硬化及动脉舒张功能障碍的关系。方法　选择CRF患者 197例和健康对照 5 3例 ,采用荧光偏振免疫分析法测定血浆总同型半胱氨酸 (tHcy)水平 ,用高分辨超声技术检测颈总动脉内膜 中层厚度 (IMT)、粥样硬化斑块以及反应性充血后和含服硝酸甘油后肱动脉内径的变化率。结果　CRF患者高同型半胱氨酸血症发生率为 84 4 % ,其血浆tHcy水平 [(2 3 5 6± 11 91) μmol/L]明显高于正常对照组 [(7 97±2 6 5 ) μmol/L](P <0 0 1)。CRF患者平均IMT值和颈动脉粥样斑块检出率均明显高于年龄匹配的正常对照组 ,肱动脉反应性充血后内径增加率 (Dh)为 (4 0 5± 3 81) % ,含服硝酸甘油后内径增加率 (Dn)为 (4 94± 4 2 8) % ,均分别明显低于正常对照组Dh的 (8 81± 6 15 ) %和Dn 的 (11 72± 7 6 4 ) % (P <0 0 1)。按动脉粥样硬化严重程度分级 ,病变越重者血浆tHcy水平越高。多因素逐步回归分析显示 ,影响颈总动脉IMT的因素按影响程度依次为血浆tHcy、透析时间和年龄 (RR =0 4 84 ,P <0 0 0 1) ;影响Dh 的因素为血浆tHcy水平、年龄、透析时间和血清总胆固醇水平 (RR =0 2 6 3,P <0 0 0 1) ;影响Dn 的因素为年龄和血浆tHcy水平 (RR =0Objective To determine whether atherosclerosis may be accelerated by hyperhomocysteinemia in patients with chronic renal failure (CRF). Methods One hundred and ninety seven CRF patients and 53 healthy volunteers were included in this study. Plasma total homocysteine (tHcy) levels were measured by using fluorescence polarization immunoassay. Intima media thickness (IMT) and prevalence atherosclerotic plaques of the extracranial common carotid artery were determined by high resolution B mode ultrasonography. The changes in brachial artery diameter during reactive hyperemia (D h) and after administration of sublingual nitroglycerin (D n) were analyzed during ultrasonic examination. Results The prevalence of hyperhomocysteinemia was 84.4% in the CRF patients. The mean level of tHcy (23.56±11.91)μmol/L was significantly higher in the CRF patients than that in the healthy controls (7.97±2.65)μmol/L ( P <0.01). The prevalence of atherosclerotic plaques and the mean IMT value of carotid artery were significantly increased in CRF patients compared with that in age matched controls. Furthermore, arterial dilating function sush as D h and D n was significantly decreased in CRF patients[(D h)(4.05±3.81)% and (D n) (4.94±4.28)% ] compared with that in controls [(D h)(8.81±6.15)% and (D n) (11.72±7.64)%] ( P <0.01). The levels of plasma tHcy were coherent with intensity of atherosclerosis in the CRF patients. Multiple stepwise regression analysis showed that in CRF patients, independent risk factors associated with value of IMT were level of tHcy, age, and duration of dialysis ( RR = 0 484, P <0 001), while those associated with D h arterial dilatation were plasma tHcy level, age, duration of dialysis and total cholesterol ( RR =0 263, P <0 001) and those associated with D n were age and tHcy level ( RR =0.211, P <0 001). Conclusion The results indicate that atherosclerosis and dysfunction of arterial vasodilation in CRF patients are associated with increase of plasma t

关 键 词：慢性肾功能衰竭 动脉粥样硬化 同型半胱氨酸 动脉舒张功能障碍 荧光偏振免疫分析法 

分 类 号：R692.5[医药卫生—泌尿科学]