中国全科医学2018，Vol.21Issue(2)：160-166,7.DOI:10.3969/j.issn.1007-9572.2017.03.y05
血浆非对称性二甲基精氨酸与维持性透析患者心血管并发症的相关性研究
Relationship between Plasma Asymmetric Dimethylarginine and Cardiovascular Complications in Patients with Maintenance Hemodialysis or Peritoneal Dialysis
摘要
Abstract
Objective To investigate the relationship between plasma asymmetic dimethylarginine ( pADMA ) level and cardiovascular complications such as carotid atherosclerosis (CAS) and left ventricular hypertrophy (LVH) in patients with end-stage renal disease (ESRD) treated by maintenance hemodialysis or ambulatory peritoneal dialysis.Methods The recruited participants were all from Peking University Shenzhen Hospital,including 108 patients diagnosed with ESRD and treated by continuous renal replacement therapy in Department of Nephrology from March to November 2015(ESRD group),60 patients clinically diagnosed with chronic glomerulonephritis in 2014(CKD group),and 60 healthy individuals underwent physical examination in December 2015(control group).Biochemical markers and pADMA levels in the fasting venous blood were measured in all groups.The conditions of CAS and LVH were detected by color Doppler ultrasound in patients with ESRD. Results The three groups differed significantly in age,mean arterial blood pressure(MABP),diabetes,smoking history,smoking duration,hemoglobin(Hb),serum creatinine(Scr),albumin(ALB),triacylglycerol(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),serum phosphorus(P),serum calcium(Ca),parathyroid hormone(PTH),estimated glomerular filtration rate (eGFR) and pADMA (P<0.05).Spearman's rank correlation coefficient analysis showed that pADMA was positively correlated with age,MABP,diabetes,smoking duration and TG (P<0.05),while it was negatively correlated with Hb,ALB,HDL-C and eGFR (P<0.05).Multiple linear regression analysis showed that eGFR was an independent risk factor for pADMA(P<0.05).In the ESRD group,color Doppler ultrasound scanning found that 54 patients had no or mild CAS and 54 patients had severe CAS.These two subgroups differed substantially in age,MABP,diabetes,dialysis duration,dialysis mode,TG,pADMA,carotid intima-media thickness (cIMT) and incidence of plaques(P<0.05).Multivariate Logistic regression analysis showed that age,dialysis mode and TG were independent risk factors for the degree of CAS in patients with ESRD(P<0.05).Spearman's rank correlation coefficient analysis showed that left ventricular mass index(LVMI) showed positive correlation with MABP,smoking duration and Scr(P<0.05),but demonstrated negative correlation with Hb and ALB in ESRD patients (P<0.05).Multiple linear regression analysis showed that Scr was an independent risk factor for elevated LVMI in the ESRD patients(P<0.05).Conclusion In the patients receiving maintenance hemodialysis or peritoneal dialysis,elevated pADMA was closely related to the degree of CAS,but not the independent risk factor for it;pADMA had no significant correlation with LVMI;Scr was an independent risk factor for LVH.关键词
终末期肾脏病/慢性肾脏病/肾小球滤过率/非对称性二甲基精氨酸/动脉粥样硬化/左心室肥厚Key words
End-stage renal disease/Chronic kidney disease/Glomerular filtration rate/Asymmetic dimethylarginine/Atherosclerosis/Left ventricular hypertrophy分类
医药卫生引用本文复制引用
梁榆英,熊祖应,廖玉梅,熊子波..血浆非对称性二甲基精氨酸与维持性透析患者心血管并发症的相关性研究[J].中国全科医学,2018,21(2):160-166,7.基金项目
深圳市卫人委资助项目(201302065) （201302065）
深圳市科创委2014年科技计划资助项目(JCYJ20140415162338803) （JCYJ20140415162338803）
