血液透析相关性肌痉挛与血管内皮功能紊乱相关

Hemodialysis-related muscle cramp is associated with endothelial dysfunction

目的血液透析相关性肌痉挛的发生机制至今尚未明确,本研究探讨内皮功能紊乱与血液透析相关性肌痉挛的相关性。方法共收集15例血液透析中频发肌痉挛(A组)和12例无肌痉挛发作史(B组)的维持性血液透析患者。于2个月的观测期内记录各组患者血液透析相关性肌痉挛的发作次数,并于观测期内透析间日检测肱动脉血流介导的血管舒张功能(Flow-mediated dilatations,FMD)和血浆血管性假性血友病因子(vWF)。结果在2组基本状况基本一致的情况下,于观察期内,A组的血液透析相关性肌痉挛发作次数明显高于B组(6.8±0.5比1.2±0.1次/4周,t=38.05,P<0.01)。检测和统计分析发现,A组患者的FMD显著低于B组患者(6.9±2.5比12.4±2.3,t=-5.88,P<0.01),而vWF的水平明显高于B组(235.7±56.2比133.7±18.3,t=6.02,P<0.01)。统计分析还表明,FMD与患者的肌痉挛次数显著负相关(r=-0.61,P<0.05),而vWF与患者的肌痉挛次数显著正相关(r=0.55,P<0.05)。结论血液透析相关性肌痉挛可能与患者的内皮功能紊乱相关,改善患者内皮功能可能有利于避免血液透析相关性肌痉挛。

Subjective The mechanism of muscle cramp in hemodialysis patients is not well understood. This study aimed to determine the relationship between endothelial dysfunction and hemodialysis-related muscle cramps. Methods Fifteen hemodialysis patients with frequent muscle cramps （group A）, and twelve hemodialysis patients without muscle cramps （group B） were enrolled. The episodes of hemodialysis-related muscle cramps were recorded over a 2-month period. Flow-mediated dilatation was measured in brachial artery, and plasma vWF was measured at the mid-interdialysis day in second month of the period. Results The incidence of symptomatic muscle cramps was significantly higher in group A than in group B （6.8：i：0.5 vs. 1.2±0.1 times/4 weeks, t=-38.05, P〈0.01）. Flow-mediated dilatation was significantly lower in group A comparing with that in group B （6.94-2.5 vs. 12.4±2.3, t=--5.88, P 〈 0.01）. In addition, plasma vWF was significantly higher in group Athan in group B （235.7-4-56.2 vs. 133.7±18.3, t=6.02, P〈0.01）. The frequency of hemodialysis-related cramps was adversely correlated with the value of flow-mediated dilation （r=-0.61, P〈 0.05）, and positively correlated with the plasma level ofvWF （r=0.55, P ~ 0.05）. Conclusion Endothelial dysfunction is associated with frequent hemodialysis-related cramps. Improving endothelial dysfuction