不对称二甲基精氨酸在慢性肾脏病患者动脉粥样硬化发生和发展中的作用

Effect of asymmetric dimethylarginine on development of atherosclerosis in patients with chronic kidney disease

不对称二甲基精氨酸(asymmetric dimethylarginine,ADMA)是内源性一氧化氮合酶抑制剂,与动脉粥样硬化(atherosclerosis,AS)发病率相关。慢性肾脏病(chronic kidney disease,CKD)患者体内ADMA水平升高。作为CKD早期内皮功能失调的预测指标及AS的血清学标志物,ADMA可直接导致或间接促进AS发生和发展,且其体内浓度较稳定,不易受其他因素的影响而波动,对CKD患者AS及其不良事件的预测价值极高,不仅可用于早期发现AS,也可通过监测其动态变化了解早期干预的有效性及患者对治疗的反应性,有助于了解疾病进展及预测预后。文章综述了CKD患者体内ADMA升高的原因及其在促进AS发生和发展中的作用。

Asymmetric dimethylarginine(ADMA)is an endogenous nitric oxide synthase inhibitor and is associated with the incidence of atherosclerosis(AS).ADMA is increased in patients with chronic kidney disease(CKD),which is a predictor of early endothelial dysfunction in CKD and a serologic marker of AS.ADMA can directly lead to or indirectly promote AS,and the concentration of ADMA in vivo is relatively stable,not being easily influenced by other factors.So the prediction value of ADMA for AS and its adverse events in CKD patients is extremely high.ADMA can not only be used for early detection of AS but also be used for reflecting the effectiveness of early intervention and patients’response to treatment by monitoring its dynamic changes,helping in understanding the progress and predicting the prognosis of the disease.This paper reviews the causes of the increase of ADMA and its role in promoting the development of AS in CKD patients.