尿毒症血液透析患者高同型半胱氨酸血症与心血管结构和功能的关系

The investigation of the relationship between hyperhomocyseinemia and cardiovascular structure and function in hemodialysis patients

目的 探讨尿毒症血液透析患者血浆同型半胱氨酸水平与心血管结构及功能的关系。方法 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 ,应用GEVV 5型彩色多普勒超声诊断仪检测颈动脉内膜 -中层厚度 (IMT)、舒张末期室间隔厚度、左心室后壁厚度、左心室舒张末期容积、左心室射血分数、二尖瓣E峰、二尖瓣A峰 ,并根据公式计算颈动脉Young’s弹性指数、左心室重量指数、心脏输出指数、舒张末期容积指数、二尖瓣E峰 /二尖瓣E峰 (E/A)比值。结果 尿毒症血液透析患者高同型半胱氨酸血症发生率为 6 8.3% ,尿毒症血液透析患者血浆tHcy水平 (2 7.75± 8.97) μmol/L明显高于正常对照组 (8.87± 2 .35 )μmol/L (P <0 .0 5 )。尿毒症血液透析患者至少一项心血管指标异常的占 83.3% (5 0 / 6 0 ) ,心血管指标异常者中高tHcy的占 82 .4 % ,心血管指标异常组与正常组高tHcy的发生率组间有显著性差异 (P <0 .0 5 )。IMT ,颈动脉Young’s弹性指数、舒张末期室间隔厚度与血浆tHcy水平呈正相关 (相关系数r分别为 0 .34,0 .31,0 .2 3,P均 <0 .0 5 )。而射血分数、E/A比值与血浆tHcy呈负相关 (相关系数r分别为 - 0 .35 ,- 0 .2 1,P均 <0 .0 5 )。这种相关性在应用多元Logistic回归剔除了性别、年龄、血压。

Objective To investigate the relationship between hyperhomocyseinemia and cardiovascular structure and function in hemodialysis patients. Methods Plasma total homocysteine (tHcy) levels were measure by fluorescence polarization immunoassay. Carotid Intima-Media thickness (IMT) and cardiovascular structure were measured by GEVV 5 echocardiography. Cardiovascular parameters including carotid Young's elastic index, left ventricular mass index, ejection fraction, left ventricular end diastolic volume index,E/A ratio were calculated by established formule. Results The prevalence of hyperhomocyseinemia was 68.3% in the hemodialysis patients. The mean level of tHcy in hemodialysis patients was (27.75±8.97)μmol/L which was significantly higher than that in the healthy controls tHcy level was (8.87±2.35) μmol/L(P<0.05). The prevalence of hyperhomocyseinemia was 82.4% in the hemodialysis patients with abnormal cardiovascular structure. Carotid IMT, carotid Young's elastic index, end-diastolic interventricular septum thickness were positively and independently correlated with tHcy the value were 0.34, 0.31 and 0.23 respectively. Multivariate stepwise regression indicated that the correlation also existed independently of other conventional risk factors such as age, sex blood pressure,Scr and glucose, While left ventricular ejection fraction and E/A was negatively correlated with tHcy(r=-0.35 and -0.21 respectively). Conclusions The results indicate that hyperhomocyseinemia may be an independent risk factor for cardiovascular disease in hemodialysis patients and it may affect cardiovascular structure and function.