维持性血液透析患者高瘦素血症与动脉粥样硬化的关系

Relationship between hyperleptinemia and atherosclerosis in maintenance hemodialysis patients

目的研究维持性血液透析(MHD)患者血浆瘦素(Leptin)水平与动脉粥样硬化的关系。方法1997-012003-06对同济大学附属同济医院的MHD患者和健康对照组测定血浆Leptin水平,及其颈总动脉内膜-中层厚度(CCA-IMT)和粥样硬化斑块。结果MHD患者血浆Leptin水平高于正常对照组(P<0·01)。其IMT及斑块检出率也明显高于年龄、性别匹配的正常对照组。MHD组患者血浆Leptin和肿瘤坏死因子(TNF-α)(均取对数值)水平与平均IMT(r=0·619,P<0·001;r=0·792,P<0·001)呈显著正相关。多因素逐步回归分析结果表明,影响颈动脉IMT的因素有血浆Leptin(对数值)及TNF-α(对数值)。结论MHD患者均存在不同程度的动脉粥样硬化;高Leptin血症是MHD患者加速动脉粥样硬化发生的危险因素。

Objective To determine whether plasma Leptin level is associated with atherosclerosis in maintenance hemodialysis （MHD） patients. Methods During 1997 -01 - 2003 -06, plasma Leptin levels in MHD patients and healthy volunteers were measured and intimamedia thickness （IMT） and prevalence of atherosclerotic plaques of the extracranial common carotid artery were also measured. Results Plasma Leptin levels in the MHD patients were higher than those in the healthy volunteers （P 〈 0. 01 ）. The prevalence of atherosclerotic plaques and the mean IMT value of carotid artel＂y were significantly increased in MHD patients compared with those in age and gender - matched controls. The levels of plasma transformed Leptin and TNF - α were positively correlated with CCA - IMT （ r = 0. 619, P 〈 0. 001 ; r =0. 792, P 〈0. 001 ） respectively. Multiple stepwise regression analysis showed that in MHD patients the independent risk factors associated with value of IMT were plasma transformed Leptin levels, and transformed TNF -α levels. Conclusion The degrees of atherosclerosis in MHD patients are different. The atherosclerosis is associated with increase of plasma Leptin levels. Hyperleptinaemia may be an independent risk factor for atherosclerosis in MHD patients.