中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (10): 695-698.doi: 10.3969/j.issn.1671-4091.2014.10.005

• 临床研究 • 上一篇    下一篇

血液透析患者肺动脉高压与血管内皮功能紊乱的相关性

宋金辉,刘佳,邢昌赢   

  1. 南京医科大学第一附属医院 江苏省人民医院肾内科
  • 收稿日期:2014-04-04 修回日期:2014-06-06 出版日期:2014-10-12 发布日期:2014-10-21
  • 通讯作者: 邢昌赢 cyxing62@126.com E-mail:jiajj3@sina.com

Correlation between pulmonary arterial hypertension and vascular endothelial dysfunction in maintenance hemodialysis patients

  • Received:2014-04-04 Revised:2014-06-06 Online:2014-10-12 Published:2014-10-21

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摘要： 目的研究维持性血液透析(maintenance hemodialysis,MHD)患者肺动脉高压(pulmonary hypertension,PAH)与内皮细胞功能紊乱之间的关系。方法选取维持性血液透析患者60 名，行心脏彩超检查，以肺动脉收缩压(PASP)≥35mmHg 的为肺动脉高压组(PAH 组)，PASP＜35 mmHg 的为无肺动脉高压组(无PAH 组)，分别收集2 组患者临床资料和实验室数据，在透析间期测量2 组患者血流介导的肱动脉内皮依赖性舒张功能(FMD)及人血不对称二甲基精氨酸(ADMA)浓度。结果60 例患者17 人存在PAH(28.3%)，PAH 组和无PAH 组患者透析间期体质量增加量与干体质量比值及高敏C 反应蛋白(hs-CRP)存在显著差异(P＜0.05)。经检测PAH 组和无PAH 组FMD 分别为(12.2±1.3)%和(6.9±1.2)%，ADMA 分别为(2.97±0.31)μmol/L 和(2.10±0.29)μmol/L，采用协方差分析法矫正可能和血管内皮功能相关的其他因素后，得出FMD 和ADMA 在两组之间均有显著差异(F=63.8，P＜0.001，F=16.832，P＜0.01)。二分类Logistic 回归分析显示，左心室质量分数(LVMI(B=0.037，P=0.043)和ADMA(B=9.519,P=0.006)是MHD患者并发PAH 的主要相关因素。结论MHD 合并PAH 的患者存在显著的血管内皮细胞功能紊乱，LVMI和人血ADMA是MHD 患者并发PAH的主要相关因素。

关键词: 血液透析, 肺动脉高压, 血管内皮细胞功能紊乱, 血流介导的肱动脉内皮依赖性舒张功能, 不对称二甲基精氨酸

Abstract: Objective To investigate the correlation between pulmonary arterial hypertension (PAH) and vascular endothelial dysfunction in maintenance hemodialysis (MHD) patients. Methods We enrolled 60 MHD patients and assigned them into 2 groups, PAH group with pulmonary artery systolic pressure (PASP) > 35 mmHg, and non-PAH group with PASP <35 mmHg. Laboratory and clinical data were collected. Flow-mediated dilatation (FMD) was measured in brachial artery, and asymmetric dimethylarginine (ADMA) was measured at the mid-interdialysis day. Results Seventeen patients (28.3%) were diagnosed as PAH. Ratio of interval dialysis weight gain and dry weight (IDWG/DW) and high sensitivity C-reactive protein (hs-CRP) were significantly higher in PAH group than in non-PAH group (P＜0.05). After excluding other factors possibly related to endothelial dysfunction by analysis of covariance, FMD was 12.2±1.3% in PAH group, significantly higher than 6.9±1.2% in non-PAH group (F=63.8, P＜0.001), and ADMA was 2.97±0.31 μmol/L in PAH group, significantly higher than 2.10±0.29 μmol/L in non-PAH group (F=16.832, P＜0.01). Logistic regression revealed that left ventricular mass index (LVMI) (B=0.037, P=0.043) and ADMA (B=9.519, P=0.006) were the major factors for PAH. Conclusions PAH was significantly correlated with vascular endothelial dysfunction in MHD patients. LVMI and ADMA were the major factors for PAH.

Key words: Hemodialysis, Pulmonary hypertension,, Endothelial dysfunction, Flow-mediated dilation, Asymmetric dimethylarginine