维持性血液透析患者血浆脂蛋白相关磷脂酶A_2与心脏结构及功能的关系

Effect of plasma lipoprotein-associated phospholipase A_2 levels on structure and function of heart in patients undergoing maintenance hemodialysis

目的研究维持性血液透析(maintenance hemodialysis,MHD)患者血浆脂蛋白相关磷脂酶A_2(lipoprotein-associated phospholipaseA_2,Lp-PLA_2)水平与心脏结构及功能的关系。方法选取我院70例透析充分病情稳定的MHD患者(接受透析治疗时间均>6个月)收集一般临床资料,采用双抗体夹心酶联免疫吸附法测定血浆Lp-PLA_2浓度,采用免疫荧光法检测血清B型脑钠肽(brain natriuretic peptide,BNP)水平;应用心脏彩超测定左心房内径(left atrial diameter,LAD)、左心室舒张末期内径(left ventricular end-diastolicdiameter,LVEDD)、左心室后壁厚度(left ventricular posterior wall depth,LVPWD)、左心室射血分数(left ventricular ejection fraction,LVEF)等各项指标,计算左心室心肌质量指数(left ventricular mass index,LVMI);分析血浆Lp-PLA_2水平与心脏彩超测定指标的相关性。以40名健康体检者作为正常对照组。结果(1)70例MHD患者中,血浆Lp-PLA_2浓度、BNP、LVEF、LVMI、收缩压均显著高于正常对照组(P<0.05)。(2)合并左室收缩功能降低(LVEF<50%)、左室肥厚和(或)心功能不全(BNP>300 ng/L)的MHD患者血浆Lp-PLA_2浓度均较相关指标正常的MHD患者明显增高(P<0.05)。(3)相关分析结果显示:MHD患者血浆Lp-PLA2水平与BNP(r=0.43,P<0.05)、LVMI(r=0.58,P<0.01)呈正相关,与LⅦF呈负相关(r=-0.67,P<0.叭)。(4)多元回归分析显示:MHD患者血浆Lp-PLA_2水平与LVMI(β=0.342,P<0.01)和左室收缩功能减退相关(β=-0.396,P<0.01)。结论在MHD患者中普遍存在高脂蛋白相关磷脂酶A_2血症;血浆Lp-PLA_2水平能反映左心室结构和功能的变化,对左心室肥厚和左心室功能的评估具有重要作用。

Objective To investigate the clinical application of plasma lipoprotein-associated phospholipase phospholipaseA2 （ Lp-PLA2 ） levels in evaluation of structure and function of heart in pa- tients undergoing maintenance hemodialysis （MHD）. Methods Seventy MHD patients were involved in the study, who were treated with MHD for at least 6 months before the study and in a stable clinical status. The plasma Lp-PLA2 levels were examined by ELISA. The serum B-type natriuretic peptide （BNP） levels were measured by immunofluorescent assay. The parameters of left ventricular end-di- astolic diameter （LVEDD）, left atrial diameter （LAD）, left ventricular posterior wall depth （LVP- WD） and left ventricular ejection fraction （LVEF） were measured by cardiac color ultrasound, the left ventricular mass index （LVMI） was calculated, and the relationship between plasma Lp-PLA2 levels and parameters determined by cardiac color ultrasound was analyzed. Another 40 healthy volunteers served as normal control group. Results （1） The levels of Lp-PLA2, BNP, LVMI, LVEF and sys- tolic pressure in MHD group were significantly higher than those in normal control group （P〈0.05）. （2） In MHD group, the patients with abnormal LVEF （LVEF〈50%）, left ventricle hypertrophy and/or cardiac insufficiency （BNP〉300 ng/L） had higher levels of Lp-PLA2 than the other patients without abnormal LVEF （LVEF〉 50 % ）, left ventricle hypertrophy and/or cardiac sufficiency （BNP 〈300 ng/L）. （3） The plasma Lp-PLA2 level was positively correlated with the levels of BNP （r= 0.43, P〈0.05） and LVMI （r= 0.58, P〈0.01 ）, but negatively with the level of LVEF （r= - 0.67, P〈0.0l ） in patients undergoing MHD. （4） Multiple stepwise regression analysis demon- strated that the plasmaLp-PLA2 level was correlated with the levels of LVMI （β= 0. 342, P〈0.01 ） and LVEF （β = - 0. 396, P〈0.01 ）. Conclusions Higher plasma Lp-PLA2 levels extensively exists in patients undergoing MHD. Plasma Lp-PLA2 level can reflect structure and function of left ventricle, which may play an important role in the evaluation of left ventricular hypertrophy and function of left ventricle.