硫酸吲哚酚与血液透析患者左心室肥厚关系的研究

The relationship between indoxyl sulfate and left ventricular hypertrophy in hemodialysis patients

目的 研究血液透析患者的血浆硫酸吲哚酚（IS）与左心室肥厚（LVH）的关系.方法 对符合标准的血液透析患者（年龄≥18岁,透析龄＞6个月,排除3个月内曾发作充血性心力衰竭以及合并心脏室壁瘤形成的患者）,收集临床资料,检测生化指标和心脏超声.应用高效液相色谱-电喷雾-串联质谱（HPLC-ESI-MS/MS）方法检测血浆IS.采用线性回归和Logistic回归模型分析血浆IS与左心室质量指数（LVMI）以及LVH的关系.结果 共入选血液透析患者210例（男性117例）,平均年龄（57.2±14.3）岁,LVH的患病率达64.0％.单因素线性回归显示,血浆IS与LVMI呈正相关（β=7.09,P=0.02）,校正各种危险因素后IS与LVMI的关系仍有意义（β=4.16,P=0.03）.将所有患者分为LVH组和非LVH组,采用Logistic回归分析IS与LVH的关系,校正各种危险因素后血浆IS与LVH独立正相关（β=6.54,OR=1.13,95％CI 1.09～1.44,P=0.03）.结论 血液透析患者血浆IS与LVMI呈独立正相关,是LVH的独立危险因素.

Objective To investigate the relationship between indoxyl sulfate （IS） and left ventricular hypertrophy （LVH） in hemodialysis patients.Methods For the eligible patients （age ≥ 18 years,dialysis duration 〉 6 months,without history of congestive heart failure within 3 months and comorbidity of cardiac aneurysm）,clinical data were collected,biochemical measurements were completed,and echocardiographic examinations were performed.Plasma IS concentration was determined by high performance liquid chromatography electrospray tandem spectrometry （HPLC-ESI-MS/MS）.Linear and Logistic regression models were employed to assess the associations of plasma IS and left ventricular mass index （LVMI） and LVH,respectively.Results Two hundred and ten hemodialysis patients （117 males） with mean age of（57.2 ± 14.3）years were enrolled.The prevalence of LVH was up to 64.0%.Univariate linear regression showed that plasma IS was positively correlated with LVMI （β=7.09,P=0.02）.The result persisted after adjustment for all kinds of risk factors （β=4.16,P=0.03）.Patients were categorized into two groups：LVH and non-LVH group.Logistic regression modelswere employed to assess the relationship of plasma IS and LVH.The result showed that plasma IS was independently associated with LVH after adjustment for other confounding risk factors （β=6.54,OR=1.13,95%CI 1.09-1.44,P=0.03）.Conclusions LVH is prevalent in hemodialysis patients.Plasma IS is significantly correlated with LVMI and the independent risk factor for LVH.