维持性血液透析患者中影响非对称性二甲基精氨酸的因素研究

Investigation of the factors affecting plasma ADMA level in maintenance hemodialysis patients

目的研究透析中血压变化特点及影响血浆非对称性二甲基精氨酸(asymmetric dimethylarginine,ADMA)的因素。方法选取237例多中心维持性血液透析患者,根据是否发生透析中低血压和高血压分为透析龄相匹配的3组,检测透析前后ADMA及一氧化氮代谢产物(nitric oxide productions,N0x)水平,探究影响ADMA的因素。结果与透析前平均动脉压相比,低血压组及高血压组在其余透析时间与基础水平相比均有显著性差异(低血压组在透析1h、2h及结束时P值分别为<0.001,<0.001,0.001;高血压组P值分别为0.017,<0.001,<0.001),低血压组的年龄、女性比例、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、脑钠肽(brain natriuretic peotide,BNP)高于高血压组(P值分别为0.008,0.252,0.018,<0.001)和平稳组(P分别为0.018,0.005,0.006,<0.001),低血压组的透析间期体质量增长大于高血压组(P=0.014),而钠离子浓度显著低于高血压组(P=0.038)和平稳组(P=0.007),高血压组的BNP高于平稳组(P<0.001),透析前低血压组(P<0.001)与高血压组(P=0.012)的ADMA水平高于透析平稳组。多元线性回归显示ADMA与年龄、iPTH、BNP正相关(t分别为3.236,4.616,2.430;P分别为0.005,<0.001,0.027)。结论透析中血压波动发生率较高,年龄、iPTH、BNP是透析患者ADMA升高的独立影响因素。

Objective To study blood pressure change during dialysis and the factors influencing the level of plasma asymmetric dimethylarginine(ADMA).Methods We recruited 237 maintenance hemodialysis(MHD)patients from multiple centers.They were divided into intradialytic blood pressure stable group,hypotension group and hypertension group;dialysis age was comparable in the 3 groups.Intradialytic blood pressure fluctuation was recorded.Clinical biochemical indicators before dialysis,plasma ADMA and nitric oxide productions(N0x)before and after dialysis were recruited.Multivariate linear regression was used to analyze the independent factors associated with ADMA.Results Compared with the mean arterial pressure before dialysis,there were significant differences in dialysis time and basal levels between hypotension group and hypertension group(P<0.05).Age,female proportion,intact parathyroid hormone(iPTH)and brain natriuretic peptide(BNP)were significantly higher in hypotension group than in hypertension group(P=0.008,0.252,0.018 and<0.001,respectively)and stable group(P=0.018,0.005,0.006 and<0.001,respectively).Interdialytic body weight gain was higher in hypotension group than in hypertension group(P=0.014),while sodium ion concentration was significantly lower in hypotension group than in hypertension group(P=0.038)and stable group(P=0.007).BNP was higher in hypertension group than in stable group(P<0.001).ADMA before dialysis was higher in hypotension group(P<0.001)and hypertension group(P<0.012)than in stable group.Multiple linear regression revealed a positive correlation of ADMA with age,iPTH and BNP(t=3.236,4.616 and 2.430,respectively;P=0.005,0.000 and 0.027,respectively).Conclusion The prevalence of intradialytic blood pressure fluctuation was high.Age,iPTH and BNP were the independent factors for elevated ADMA in MHD patients.