上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (7): 917-.doi: 10.3969/j.issn.1674-8115.2012.07.020

• 论著（临床研究） • 上一篇    下一篇

维持性血液透析患者血浆同型半胱氨酸水平与心脏结构和功能的关系

陆 玮, 单剑萍, 季 刚, 吴谷奋, 蒋更如   

  1. 上海交通大学 医学院附属新华医院肾内科, 上海 200092
  • 出版日期:2012-07-28 发布日期:2012-08-17
  • 作者简介:陆 玮（1968—）, 女, 副主任医师, 硕士；电子信箱: luweixh68@yahoo.com.cn。

Relationship between plasma homocysteine levels and structure and function of heart in patients undergoing maintenance hemodialysis

LU Wei, SHAN Jian-ping, JI Gang, WU Gu-fen, JIANG Geng-ru   

  1. Department of Nephrology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
  • Online:2012-07-28 Published:2012-08-17

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摘要：

目的 探讨血浆同型半胱氨酸（Hcy）水平在维持性血液透析（MHD）患者心脏结构和功能评估中的应用价值。方法 69例透析龄≥6个月的MHD患者(MHD组）根据有无心血管疾病（CVD）事件发生分为MHD合并CVD组（MHD-CVD组，n=26）和MHD未合并CVD组（MHD-nCVD组,n=43）。采用ELISA法检测透析前和透析后即刻（透后即刻）的血浆Hcy浓度；应用心脏彩超测定左心室舒张末期内径（LVEDD）、左心房内径（LAD）、左心室后壁厚度（LVPWD）、左心室射血分数（LVEF）等指标，计算左心室质量（LVM）；分析血浆Hcy水平与心脏彩超测定指标的相关性。以42名健康志愿者作为正常对照组。结果 MHD组透析前和透后即刻的血浆Hcy浓度均显著高于正常对照组（P<0.01）；透析前，MHD-CVD组血浆Hcy浓度显著高于MHD-nCVD组（P<0.05）。相关性分析结果显示：MHD患者血浆Hcy水平与LVEDD、LVPW、LVM和LAD呈正相关（r=0.315，P=0.008；r=0.355，P=0.003；r= 0.314，P=0.009；r=0.248，P=0.040），与LVEF呈负相关(r=－0.262，P=0.030)。在透后即刻血浆Hcy浓度较透析前下降≥50%的MHD患者中，透后即刻血浆Hcy水平降低与LVPWD呈正相关（r=0.401，P=0.036），其中MHD-CVD组透后即刻血浆Hcy水平降低与LVEDD和LVESD呈负相关(r=－0.419，P=0.031; r=－0.534，P=0.008)。结论 MHD患者（尤其是合并CVD的患者）普遍存在高同型半胱氨酸血症。血浆Hcy水平能反映LVM及左心室结构和功能的变化，对左心室肥厚和左心室功能的评估具有重要作用。

关键词: 维持性血液透析, 血浆同型半胱氨酸, 心脏, 结构, 功能

Abstract:

Objective To investigate the clinical application of plasma homocysteine (Hcy) levels in evaluation of structure and function of heart in patients undergoing maintenance hemodialysis (MHD). Methods Sixty-nine patients with MHD for no less than six months were selected (MHD group). According to the incidence of cardiovascular disease (CVD) events, patients were divided into MHD-CVD group (MHD complicated with CVD, n=26) and MHD-nCVD group (MHD without complication with CVD, n=43). The plasma Hcy levels before hemodialysis and immediately after hemodialysis were examined by ELISA, the parameters of left ventricular enddiastolic diameter (LVEDD), left atrial diameter (LAD), left ventricular posterior wall depth (LVPWD) and left ventricular ejection fraction (LVEF) were measured by cardiac color ultrasound, the left ventricular mass (LVM) was calculated, and the relationship between plasma Hcy levels and parameters determined by cardiac color ultrasound was analysed. Another 42 healthy volunteers were served as normal control group. Results The plasma Hcy levels in MHD group were significantly higher than those in normal control group before hemodialysis and immediately after hemodialysis (P<0.01). The plasma Hcy level in MHD-CVD group was significantly higher than that in MHD-nCVD group before hemodialysis (P<0.05). The plasma Hcy level was positively related to LVEDD, LVPW, LVM and LAD (r=0.315, P=0.008; r=0.355, P=0.003; r=0.314, P=0.009; r=0.248, P=0.040), and was negatively related to LVEF (r=－0.262, P=0.030) in patients undergoing MHD. In patients whose plasma Hcy levels immediately after hemodialysis decreased by no less than 50% of those before hemodialysis, the decrease of plasma Hcy level immediately after hemodialysis was positively related to LVPWD (r=0.401, P=0.036), and the decrease of plasma Hcy level was negatively related to LVEDD and LVESD in MHD-CVD group (r=－0.419, P=0.031; r=－0.534, P=0.008). Conclusion Hyperhomocysteinemina extensively exists in patients undergoing MHD, especially in those complicated with CVD. Plasma Hcy level can reflect LVM and structure and function of left ventricle, which may play an important role in the evaluation of left ventricular hypertrophy and function of left ventricle.

Key words: maintenance hemodialysis, homocysteine, heart, structure, function