不同腹膜转运特性对腹膜透析患者血管内皮功能及CRP、Hcy的影响

发布时间：2018-08-25 15:27

【摘要】：目的:本文采用肱动脉FMD作为评估血管内皮功能的指标,超敏C反应蛋白(CRP)为衡量微炎症的指标,观察不同腹膜转运特性对血管内皮功能及CRP、Hcy的影响,为评估心血管事件提供临床依据。方法:选取2015年1月~2016年12月山西医科大学第一医院肾内科,行持续性不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者70例,按照腹膜平衡(PET)试验分为2组,即高转运组和低转运组,分别记录患者的一般情况,检测患者血浆超敏CRP及同型半胱氨酸(Hcy),同时检测血肌酐(Scr)、血尿素(BUN)、血清白蛋白(ALB)、血钙(Ca)、血磷(P)、甲状旁腺激素(iPTH)等生化指标,采用肱动脉血流介导的血管扩张(FMD)评估血管内皮功能,分析不同腹膜转运特性对血管内皮功能及CRP、Hcy的影响。应用SPSS 19.0软件包进行统计分析。结果:1.两组患者在性别、年龄、体质指数(BMI)、透析龄上,差异无统计学意义(P0.05),Ca、P、i PTH、BUN和Scr差异无统计学意义(P0.05);与低转运组相比,高转运组患者的ALB显著降低,差异具有统计学意义(P0.01)。2.两组患者的原发病差异无统计学意义(P0.05)。3.高转运组FMD值(3.96±1.11)%低于低转运组FMD(6.05±0.95)%(P0.01);高转运组CRP水平中位数(3.88)mg/L高于低转运组(2.82)mg/L(P0.05);高转运组Hcy(29.88±2.25)mol/L低于低转运组(31.90±2.21)mol/L,差异均有统计学意义(P0.01)。4.PD患者的FMD值与CRP水平呈负相关(r=-0.235,P0.01),FMD与Hcy无相关性(P0.05)。结论:1.PD患者均存在不同程度的血管内皮功能紊乱,高转运组的紊乱程度较高,且血管内皮功能紊乱与CRP水平密切相关,提示改善PD患者的微炎症状态可以改善其血管内皮功能的紊乱程度。2.PD患者常存在高Hcy血症,而腹膜高转运患者的Hcy水平普遍低于低转运者,可能与PD对Hcy的清除有关。3.控制PD患者尤其是腹膜高转运患者的血管内皮功能紊乱及体内的微炎症水平,对降低心血管事件具有重要意义。
[Abstract]:Aim: to evaluate the endothelial function of brachial artery by using FMD and (CRP) as the index of microinflammation, and to observe the effects of different peritoneal transport characteristics on endothelial function and CRP,Hcy. To provide clinical basis for evaluating cardiovascular events. Methods: from January 2015 to December 2016, 70 patients with continuous ambulatory peritoneal dialysis (continuous ambulatory peritoneal dialysis,CAPD) in the Department of Renal Medicine, first Hospital of Shanxi Medical University, were divided into two groups according to peritoneal equilibrium (PET) test: high transport group and low transport group. The plasma hypersensitive CRP and homocysteine (Hcy), were measured respectively. The serum creatinine, (Scr), blood urea, (BUN), serum albumin, (ALB), (Ca), serum phosphorus, (P), parathyroid hormone (iPTH) were detected. The vascular endothelial function was evaluated by brachial artery vasodilation (FMD), and the effects of different peritoneal transport characteristics on vascular endothelial function and CRP,Hcy were analyzed. SPSS 19.0 software package was used for statistical analysis. The result is 1: 1. There was no significant difference in gender, age and BMI (BMI), dialysis age between the two groups (P0.05). There was no significant difference in PTH,BUN and Scr between the two groups (P0.05). Compared with the low transport group, the ALB in the high transport group was significantly lower than that in the low transport group (P0.01). 2. There was no significant difference in primary disease between the two groups (P0.05). 3. The FMD value of high transport group (3.96 卤1.11)% was lower than that of low transport group (6.05 卤0.95)% (P0.01), the median CRP level of high transport group (3.88) mg/L was higher than that of low transport group (2.82) mg/L (P0.05), and the Hcy (29.88 卤2.25) mol/L of high transport group was lower than that of low transport group (31.90 卤2.21) mol/L,. Conclusions: 1. The vascular endothelial dysfunction in PD patients was higher than that in the high transport group, and the vascular endothelial dysfunction was closely related to the level of CRP. It is suggested that improving the microinflammatory state of PD patients can improve the disturbance degree of vascular endothelial function. 2. Hyperlipidemia often exists in PD patients, while the Hcy level in patients with high peritoneal transport is generally lower than that in low transporters, which may be related to the clearance of Hcy by PD. It is important to control vascular endothelial dysfunction and microinflammation in patients with PD, especially in patients with high peritoneal transport.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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