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