中国血液净化

›› 2004, Vol. 3 ›› Issue (6): 308-312.

• 论著 • 上一篇    下一篇

尿毒症血液透析患者高同型半胱氨酸血症与心血管结构和功能的关系

李忠心 彭立人 沈 洋 姜 维   

  1. 100020 北京，首都医科大学附属北京朝阳医院肾内科 (李忠心，彭立人，沈洋) 心脏彩超室(姜维)
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2004-06-12 发布日期:2004-06-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2004-06-12 Published:2004-06-12

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摘要：

目的 探讨尿毒症血液透析患者血浆同型半胱氨酸水 平与心血管结构及功能的关系。方法 采用荧光偏振免疫分析法测定血浆总同型半胱氨酸（tHcy） 水平，应用GEVV 5型彩色多普勒超声诊断仪检测颈动脉内膜-中层厚度（IMT）、舒张末期室 间隔厚度、左心室后壁厚度、左心室舒张末期容积、左心室射血分数、二尖瓣E峰、二尖瓣A 峰，并根据公式计算颈动脉Young's弹性指数、左心室重量指数、心脏输出指数、舒张末期 容积指数、二尖瓣E峰/二尖瓣E峰（E/A）比值。结果 尿毒症血液透析患者高同型半胱氨酸血症发生率为68.3%，尿 毒症血液透析患者血浆tHcy水平（27.75±8.97）μmol/L明显高于正常对照组(8.87±2.35) μmol/L ( P＜0.05)。尿毒症血液透析患者至少一项心血管指标异常的占83.3%（50 /60），心血管指标异常者中高 tHcy的占82.4%，心血管指标异常组与正常组高tHcy 的发生率组间有显著性差异（ P＜0.05）。 IMT，颈动脉Young's弹性指数 、舒张末期室间隔厚度与血浆tHcy水平呈 正相关(相关系数r分别为0.34,0.31,0.23, P均＜0.05)。而射血分数、 E/A 比值与血浆tHcy呈负相关(相关系数r分别为-0.35,-0.21, P均＜0.05)。 这种相 关性在应用多元 Logistic回归剔除了性别、年龄、血压、血脂、血糖、血红蛋白等 因素影响后仍然存在。结论 高同型半胱氨酸血症可能是尿毒症血液透析患者发生心血管 疾病的独立危险因素，可导致动脉顺应性下降，直接影响心血管的结构及功能。

关键词: 血液透析, 动脉粥样硬化, 同型半胱氨酸

Abstract:

Objective To investigate the relationship be tween hyperhomocyseinemia and cardiovascular structure and function in hemodialy sis patients. Methods Plasma total homocysteine (tHcy) levels were meas ure by fluorescence polarization immunoassay. Carotid Intima-Media thickness (IMT) and cardiovasculars tructure were measured by GEVV5 echocardiography. Cardiovascular parameters inc luding carotid Young's elastic index, left ventricular mass index, ejection fraction, left ventricular end diastolic volume index, E/A ratio were calculated by established formule. Results The prevalence of hyperhomocyseinemia was 68.3% in the hemodialysis patients. The mean level of tHcy in hemodialysis patients was (27.75±8.97)μmol/L which was significantly higher than that in the healthy con trols tHcy level was (8.8 7±2.35) μmol/L( P＜0.05). The prevalence of hyperhomocyse inemia was 82.4% in the hemodialysis patients with abnormal cardiovascular struc ture. Carotid IMT, carotid Young's elastic index, end-diastolic interventricular septum thickness were positively and independently correlated with tHcy the value were 0.34, 0.31 and 0.23 respectively. Multivariate stepwise regression indicated that the correlation also existed independently of other conventional risk factors such as age, sex blood pressure, Scr and glucose, While l eft ventricular ejection fraction and E/A was negatively correlated with tHcy(r= -0.35 and -0.21 respectively). Conclusions The results indicate that hyperhomocyseinemia may be an independent risk factor for cardiovascular disease in hemodialysis pa tients and it may affect cardiovascular structure and function.

Key words: Atherosclerosis, Homocystenie 

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