维持性血液透析患者妊娠相关血浆蛋白A水平与心脏结构和功能的相关性研究

Relationship between pregnancy-associated plasma protein A and cardiac structure and function in patients with maintenance hemodialysis

目的探讨维持性血液透析(MHD)患者妊娠相关血浆蛋白A(PAPP-A)水平与心脏结构和功能的关系。方法选择86例透析病程大于或等于6个月的MHD患者为研究对象,根据有无心血管疾病(CVD)事件分为非心血管病变(MHD-nCVD)组50例和心血管病变(MHD-CVD)组36例,以40例年龄相当的健康体检者作为健康对照组,采用酶联免疫吸附试验(ELISA)检测血清PAPP-A水平和超声心动图检测心脏结构与功能,分析血清PAPP-A水平和超声心动图检测指标的相关性。结果 MHD-nCVD组和MHD-CVD组患者血清PAPP-A水平分别为(4.26±1.72)、(7.83±2.16)mIU/L,明显高于健康对照组的(1.77±0.51)mIU/L,差异有统计学意义(P<0.05),MHD-CVD组患者血清PAPP-A水平明显高于MHD-nCVD组,差异有统计学意义(P<0.05)。相关性分析显示:MHD患者PAPP-A与左心室心肌质量指数(LVMI)呈正相关(r=0.484,P<0.05),与左室射血分数(EF)呈负相关(r=-0.379,P<0.05)。结论 MHD患者存在血清妊娠相关血浆A水平增高,血清PAPP-A水平可反映LVMI及左心室结构和功能变化,对左心室肥厚及左心室功能的评估有预测作用。

Objective To evaluate the relationship between pregnancy-associated plasma protein A （PAPP-A） and cardiac structure and function in patients with maintenance hemodialysis （M HD） .Methods A total of 86 M HD patients ,with course of treatment for at least 6 months ,were divided into non-cardiovascular disease （CVD） group （M HD-nCVD group ,n=50） and cardi ovascular disease group （M HD-CVD group ,n=36） according to the state of CVD ,and 40 age-marched health subjects were enrolled as health control group .Serum levels of PAPP-A were deter-mined by ELISA ,and cardiac structure and function were evaluated by echocardiography .The correlations between serum level of PAPP-A and indexes of echocardiogram were analyzed .Results Serum levels of PAPP-A in both MHD-nCVD group and MHD-CVD group ,which were （4 .26 ± 1 .72） and （7 .83 ± 2 .16）mIU/L respectively ,were significantly higher than that of control group ,which was （1 .77 ± 0 .51）mIU/L （P〈0 .05） .Serum level of PAPP-A in M HD-CVD group was significantly higher than that of M HD-nCVD group （ P〈 0 .05 ） .Correlation analysis showed that level of PAPP-A in patients with M HD was positively correlated with left ventricular mass index （LV-MI ,r=0 .484 ,P〈0 .05） ,and negatively correlated with left ventricular ejection fraction （LVEF ,r= -0 .379 ,P〈0 .05） .Conclusion Serum level of PAPP-A in patients with MHD might be high ,which could reflect LVMI and left ventricular structure and function ,and could evaluate left ventricular hypertrophy and left ventricular function .