胎球蛋白A对腹膜透析患者心肾功能的影响

Effect of fetuin A on cardiac and kidney function in patients with peritoneal dialysis

目的探讨胎球蛋白A对腹膜透析(PD)患者心肾功能的影响。方法选取2014年2月至2016年2月于该院行初始PD的86例患者为研究对象。根据胎球蛋白A检测水平,将≥280mg/L的患者纳入高胎球蛋白A组,<280mg/L的患者纳入低胎球蛋白A组。检测2组患者入组前和研究结束时的生化指标、心功能指标[左室射血分数(LVEF)、左室舒张内径(LVDd)和舒张期室间隔厚度(LVST)]和残存肾功能(RRF)。结果入组时,高胎球蛋白A组与低胎球蛋白A组患者RRF水平分别为(11.25±3.95)、(8.35±3.15)mL/min,差异无统计学意义(t=0.536,P>0.05)。研究结束时高胎球蛋白A组与低胎球蛋白A组患者RRF水平分别为(11.02±4.13)、(5.63±2.01)mL/min,与入组时比较,均明显降低,差异均有统计学意义(t=2.236、2.218,P<0.05),且组间比较差异有统计学意义(t=2.158,P<0.05)。入组时,高胎球蛋白A组与低胎球蛋白A组患者LVEF、LVDd和LVST比较,差异均无统计学意义(t=0.965、1.311、0.853,P>0.05)。研究结束时,高胎球蛋白A组与低胎球蛋白A组患者LVEF均明显降低(t=2.350、2.315,P<0.05),LVDd和LVST明显上升(t=2.159、2.276、2.125、2.239,P<0.05),且组间比较差异有统计学意义(t=2.155、2.301、2.271,P<0.05)。胎球蛋白A与LVDd和LVST呈显著负相关(r=-0.712,P<0.05;r=-0.638,P<0.05),与LVEF呈显著正相关(r=0.690,P<0.05)。结论血清胎球蛋白A降低可能是导致PD患者心功能下降和残肾功能丢失的原因。

Objective To investigate the effect of fetuin A on cardiac and renal function in peritoneal dialysis patients. Methods From February 2014 to February 2016,86 patients with initial peritoneal dialysis （PD） were selected as the subjects.According to the detection level of fetuin A,≥280 mg/L patients were divided into high-dose fetuin A group,〈280 mg/L patients were divided into low-dose fetuin A group.Left ventricular ejection fraction （LVEF）,left ventricular diastolic diameter （LVDd）,diastolic ventricular septal thickness （LVST） and residual renal function （RRF） were measured before and after the study. Results At the time of enrollment,the levels of RRF in high-dose fetuin A group and low-dose fetuin A group were （ 11.25± 3.95） and （8.35±3.15） mL/min respectively,there was no significant difference （ t =0.536, P 〉 0.05 ）.At the end of the study,the levels of RRF in high-dose fetuin A group and low-dose fetuin A group were （11.02±4.13） and （5.63±2.01） mL/min respectively,compared with those at the time of entry,the RRF levels were significantly lower and the differences were statistically significant （ t = 2.236 , 2.218 , P 〈0.05）,and there was a statistically significant difference between two groups （ t =2.158, P 〈0.05）.At the time of entered this study,there was no significant difference on LVEF,LVDd and LVST between high-dose fetuin A group and low-dose fetuin A group （ t =0.965,1.311,0.853; P 〉0.05）.At the end of the study,LVEF decreased significantly high-dose fetuin A group and low-dose fetuin A group （ t = 2.35,2.315, P 〈0.05）,and LVDd and LVST increased significantly （ t =2.159,2.276,2.125, 2.239 , P 〈 0.05）,and the difference between the groups was statistically significant （ t =2.155,2.301,2.271, P 〈 0.05 ）.Fetal A correlated negatively with LVDd and LVST （ r =-0.712, P 〈0.05; r =-0.638, P 〈 0.05 ） and correlated positively with LVEF （ r =0.690, P 〈 0.05 ）. Conclusion Decreasing serum fetuin A might be the cause of cardiac function loss and residual renal function loss in PD patients.