维持性血液透析患者血氧化三甲胺与心力衰竭的相关性及其影响因素  

Correlation analysis of blood trimethylamine N-oxide level with heart failure and its influencing factors in patients undergoing maintenance hemodialysis

作　　者：杨文领[1] 何莲[1] 李育梅 赵微微[1] 陈文静[1] 杨平 张现化[2] 张爱华 ang Wenling;He Lian;Li Yumei;Zhao Weiwei;Chen Wenjing;Yang Ping;Zhang Xianhua;Zhang Aihua(Department of Nephrology,Peking University Third Hospital,Beijing 100191,China;Department of Pharmacy,Peking University Third Hospital,Beijing 100191,China;Department of Nephrology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]北京大学第三医院肾内科,北京100191 [2]北京大学第三医院药剂科,北京100191 [3]首都医科大学宣武医院肾内科,北京100053

出　　处：《中华肾脏病杂志》2021年第2期121-129,共9页Chinese Journal of Nephrology

基　　金：北京大学第三医院优秀留学回国人员科研启动基金支持(BYSYLXHG2019007)。

摘　　要：目的探讨维持性血液透析(maintenance hemodialysis,MHD)心力衰竭患者氧化三甲胺(trimethylamine N-oxide,TMAO)变化特征及其影响因素。方法选择2018年11月到2019年3月期间18~75岁行血液透析至少3个月且每周透析不低于3次的患者为研究对象,以同期体检中心参与健康体检并且没有发现明显肾脏检查异常的人员为对照(非肾病对照组)。收集研究对象的临床生化指标、原发病、透析、心脏检查等病历资料及体检资料,以高效液相-质谱法检测研究对象的血清TMAO,比较MHD患者与非肾病对照间、合并心力衰竭与无心力衰竭患者间TMAO自然对数(lnTMAO)的差异,并以线性回归分析评估lnTMAO的影响因素。结果纳入非肾病对照40例,MHD患者195例,其中有充血性心力衰竭症状和/或左心室射血分数<50%者共30例(15.4%)。MHD患者与非肾病对照组间年龄[中位数62.0(48.0,71.0)岁比45.0(33.3,55.0)岁,Z=5.685,P<0.001]、男性比例[67.2%比37.5%,χ^(2)=12.426,P<0.001]、TMAO水平[5.54(3.84,8.91)mg/L比0.17(0.11,0.30)mg/L,自然对数转换后t=21.687,P<0.001]等差异均有统计学意义,但合并心力衰竭与无心力衰竭患者间年龄[64.5(56.8,71.0)岁比61.0(47.0,72.0)岁,Z=0.894,P=0.372]、男性比例[63.3%比67.9%,χ^(2)=0.238,P=0.626]、TMAO水平[5.17(3.30,9.46)mg/L比5.57(3.87,8.95)mg/L,自然对数转换后t=-1.537,P=0.135]等差异均无统计学意义。多变量线性回归分析结果显示,在所有研究对象中,lnTMAO=0.078×[血尿素(mmol/L)]+0.001×[血肌酐(μmol/L)]-0.002×[尿酸(μmol/L)]-0.003×[血小板(×10^(9)/L)]+0.014×[年龄(岁)]+0.344(如果有糖尿病)-1.266,其中血尿素是TMAO水平的主要影响因素[标准化系数(SB)=0.483];而在血液透析患者中,lnTMAO=0.249×[超滤量(L)]+0.059×[血浆白蛋白(g/L)]+0.008×[年龄(岁)]-0.526(如果存在心力衰竭)-1.865,其中超滤量是TMAO水平的主要影响因素(SB=0.279)。结论MHD患者存在肠道微生态变化,校正多种影响因素后Objective To investigate the level of trimethylamine N-oxide(TMAO),one of gut metabolites,in patients undergoing maintenance hemodialysis(MHD)accompanied by congestive heart failure(HF)and its influencing factors.Methods Those patients of 18-75 years old who received three or more times of hemodialysis sessions per week for three months or longer during Nov 2018 and Mar 2019 were enrolled.Those attended health checkup at the same time without obvious kidney abnormality served as non-kidney disease controls.Serum TMAO concentrations were measured using high-performance liquid chromatography electrospray ionization-tandem mass spectrometry(HPLC-ESI-MS/MS).The levels of TMAO were compared between patients on hemodialysis and controls,between those with heart failure and without heart failure using logrithmically transformed TMAO(lnTMAO).Linear regression analysis was performed to investigate factors influencing TMAO levels.Results A total of 195 patients undergoing MHD and 40 controls were enrolled.Among them,30 hemodialysis cases(15.4%)manifested as heart failure symptoms and/or left ventricular ejection fraction less than 50%.Males accounted for 67.2%in patients on hemodialysis and 37.5%in controls(χ^(2)=12.426,P<0.001)respectively,while the median ages in both groups were 62.0(48.0,71.0),45.0(33.3,55.0)years old respectively(Z=5.685,P<0.001).TMAO concentrations were significantly higher in patients on hemodialysis than controls[5.54(3.84,8.91)mg/L vs 0.17(0.11,0.30)mg/L,after log transformed,t=21.687,P<0.001].However,there was no statistically significant difference between those with heat failure and those without in male[63.3%vs 67.9%,χ^(2)=0.238,P=0.626],age[64.5(56.8,71.0)years old vs 61.0(47.0,72.0)years old,Z=0.894,P=0.372]and TMAO[5.17(3.30,9.46)mg/L vs 5.57(3.87,8.95)mg/L,after log transformed,t=-1.537,P=0.135].Multivariate linear regression analysis demonstrated that in all the participants,serum urea was the main risk factor for TMAO[standardized coefficient(SB)=0.483].lnTMAO=0.078×[serum urea(mmol/L

关 键 词：心力衰竭 肾透析 营养状况 氧化三甲胺 

分 类 号：R692.5[医药卫生—泌尿科学] R541.6[医药卫生—外科学]