血浆非对称性二甲基精氨酸与维持性透析患者心血管并发症的相关性研究

Relationship between Plasma Asymmetric Dimethylarginine and Cardiovascular Complications in Patients with Maintenance Hemodialysis or Peritoneal Dialysis

目的探讨维持性透析患者血浆非对称性二甲基精氨酸(p ADMA)水平和颈动脉粥样硬化(CAS)、左心室肥厚(LVH)等心血管并发症的相关性。方法选取2015年3—11月于北京大学深圳医院肾内科诊断为终末期肾脏病(ESRD)并长期肾脏替代治疗患者108例(ESRD组),选取2014年经临床诊断为慢性肾小球肾炎患者60例[慢性肾脏病(CKD)组],选取2015年12月本院体检健康者60例(对照组)。检测各组生化指标和p ADMA水平;超声检测ESRD组患者CAS和LVH情况。结果 3组年龄、平均动脉压(MABP)、糖尿病、吸烟史、吸烟时间、血红蛋白(Hb)、血肌酐(Scr)、清蛋白(ALB)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血磷(P)、血钙(Ca)、甲状旁腺激素(PTH)、估算肾小球滤过率(e GFR)、p ADMA水平比较,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,p ADMA与年龄、MABP、糖尿病、吸烟时间、TG呈正相关(P<0.05),与Hb、ALB、HDL-C、e GFR呈负相关(P<0.05)。多元线性回归分析结果显示,e GFR是影响p ADMA水平的独立危险因素(P<0.05)。ESRD组中无或轻度CAS 54例,重度CAS 54例。无或轻度CAS和重度CAS患者年龄、MABP、糖尿病、透析时间、透析方式、TG、p ADMA、颈动脉内膜中层厚度(c IMT)、斑块发生率比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、透析方式和TG是ESRD患者CAS的独立危险因素(P<0.05)。Spearman相关分析结果显示,ESRD患者左心室心肌质量指数(LVMI)与MABP、吸烟时间、Scr呈正相关(P<0.05);与Hb、ALB呈负相关(P<0.05)。多元线性回归分析结果显示,Scr是ESRD患者LVMI升高的独立危险因素(P<0.05)。结论对于维持性透析患者,p ADMA和CAS程度相关,但并非CAS的独立危险因素,p ADMA与LVMI无相关性,Scr是LVH的独立危险因素。

Objective To investigate the relationship between plasma asymmetic dimethylarginine（ p ADMA） level and cardiovascular complications such as carotid atherosclerosis（CAS） and left ventricular hypertrophy（LVH） in patients with end-stage renal disease（ESRD） treated by maintenance hemodialysis or ambulatory peritoneal dialysis.Methods Therecruited participants were all from Peking University Shenzhen Hospital,including 108 patients diagnosed with ESRD and treated by continuous renal replacement therapy in Department of Nephrology from March to November 2015（ESRD group）,60 patients clinically diagnosed with chronic glomerulonephritis in 2014（CKD group）,and 60 healthy individuals underwent physical examination in December 2015（control group）.Biochemical markers and p ADMA levels in the fasting venous blood were measured in all groups.The conditions of CAS and LVH were detected by color Doppler ultrasound in patients with ESRD.Results The three groups differed significantly in age,mean arterial blood pressure（MABP）,diabetes,smoking history,smoking duration,hemoglobin（Hb）,serum creatinine（Scr）,albumin（ALB）,triacylglycerol（TG）,total cholesterol（TC）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,serum phosphorus（P）,serum calcium（Ca）,parathyroid hormone（PTH）,estimated glomerular filtration rate（e GFR） and p ADMA（P〈0.05）.Spearman＇s rank correlation coefficient analysis showed that p ADMA was positively correlated with age,MABP,diabetes,smoking duration and TG（P〈0.05）,while it was negatively correlated with Hb,ALB,HDL-C and e GFR（P〈0.05）.Multiple linear regression analysis showed that e GFR was an independent risk factor for p ADMA（P〈0.05）.In the ESRD group,color Doppler ultrasound scanning found that 54 patients had no or mild CAS and 54 patients had severe CAS.These two subgroups differed substantially in age,MABP,diabetes,dialysis duration,dialysis mode,TG,p ADMA,carotid intima-media thickness（c IMT） and incidence of plaques（P〈0.05）.Multivariate Logistic regression analysis showed that age,dialysis mode and TG were independent risk factors for the degree of CAS in patients with ESRD（P〈0.05）.Spearman＇s rank correlation coefficient analysis showed that left ventricular mass index（LVMI） showed positive correlation with MABP,smoking duration and Scr（P〈0.05）,but demonstrated negative correlation with Hb and ALB in ESRD patients（P〈0.05）.Multiple linear regression analysis showed that Scr was an independent risk factor for elevated LVMI in the ESRD patients（P〈0.05）.Conclusion In the patients receiving maintenance hemodialysis or peritoneal dialysis,elevated p ADMA was closely related to the degree of CAS,but not the independent risk factor for it;p ADMA had no significant correlation with LVMI;Scr was an independent risk factor for LVH.