血液透析对血ADMA水平的影响及其与心血管并发症关系的研究
发布时间：2018-08-05 20:04
【摘要】：目的：近年来学者们逐渐认识并高度重视的不对称性二甲基精氨酸(AsymmetricDimethylarginine，ADMA)是内皮功能损伤的标记物，也是心血管疾病发生的危险因子。血ADMA水平与终末期肾脏病（EndStageRenalDisease，ESRD)患者心血管疾病（Cardiovasculardisease，CVD）的发病率和死亡率相关。本研究通过测定ESRD患者采用不同通量、不同膜质的透析器透析血清ADMA水平的变化，评价血液透析对血ADMA的清除能力，探讨血ADMA水平与动脉粥样硬化及左心室肥厚等心血管疾病的关系。 方法：选择2013年10月到2013年12月于河北医科大学第二医院血液透析室行规律血液透析的病情稳定的ESRD患者60例，其中男31例，女29例，Kt／V值波动于1．2～1．4，已透析时间均大于5个月。所有患者参与分组前所应用透析器均为BaxterCAHP-150/5M2734(低通量纤维素膜透析器）。随机分为低通量纤维素膜组(CD组)、高通量纤维素膜组（CTA组）和高通量聚砜膜组(PES组)，每组各20例。选取20例体检健康者作为对照组。经统计学分析，各透析组及健康对照组年龄、性别构成均无差别。透析患者每周透析3次，每次4小时，其中PES组改用Polyfluxl7R透析器，CTA组改用BaxterCT190G/5M1546透析器，CD组继续应用BaxterCAHP-150/5M2734透析器。三种透析器均可重复使用。分别检测3组患者单次治疗前后及透析3个月后的血ADMA水平。抽取健康对照组人员的清晨空腹肘静脉血标本。采用酶联免疫吸附法（ELISA）测定各组的血ADMA含量。收集各组的年龄、性别、透龄等基本资料。所有实验组和对照组患者均在空腹12h后于第二天清晨空腹抽取静脉血以测定低密度脂蛋白(LDL-C)、总胆固醇(TC)、高密度脂蛋白(HDL-C)等生化指标。监测透析病人血压：测量透析前、透析1小时、透析2小时、透析3小时和透析结束时的血压并计算平均动脉压。采用PhilipsIE33超声诊断系统进行心脏超声检查，记录心动周期末期室间隔厚度（IVST）、左室舒张末期的内径（LVDd）、左室后壁的厚度（LVPWT）、左心室射血分数（LVEF），在不同扫描中重复测量3次取平均值。采用PhilipsIU22超声诊断系统探测各组透析病人及健康对照组双侧颈总动脉内膜-中层厚度（IMT）、有无斑块形成等。采用SPSS16.0统计软件包行统计学分析，，认为P＜0.05有统计学差异，P＜0.01差异显著。 结果： 1CD组、CTA组、PES组患者血ADMA水平较健康对照组升高，P＜0.05。健康对照组血ADMA水平为0.34±0.14umol/L，CD组血ADMA水平最高为1.23±0.15umol/L，CTA组居中0.95±0.11umol/L，PES组水平最低为0.66±0.09umol/L。ESRD患者血ADMA水平与常规指标的Pearson相关分析显示：ADMA与MABP(r=0.583，P＜0.05)呈正相关，与Hb(r=-0.316，P＜0.05)呈负相关。 2PES组患者治疗前血ADMA水平为0.66±0.09umol/L，治疗后为0.23±0.07umol/L，P＜0.01，差异显著；CTA组治疗前血ADMA水平为0.95±0.11umol/L，治疗后为0.70±0.12umol/L，P＜0.01，差异显著；CD组治疗前血ADMA水平为1.23±0.15umol/L，治疗后为0.97±0.09umol/L，P＜0.01，差异显著。三种治疗前后ADMA差值相比P＜0.05，差异有统计学意义。PES组与CTA组相比P＜0.05，差异有统计学意义；PES组与CD组相比，P＜0.05，差异有统计学意义；而CTA组与CD组相比，P＞0.05，差异无统计学意义。PES组治疗3个月后血ADMA水平为0.31±0.11umol/L，比3个月前有所下降，P＜0.01，差异显著；CTA组治疗3个月后血ADMA水平为0.93±0.12umol/L，与3个月前相比无明显差别，P＞0.05；CD组治疗3个月后血ADMA水平为1.21±0.17umol/L，与3个月前相比无明显差别，P＞0.05。三种治疗3个月后ADMA差值比较，P＜0.01，差异显著。PES组与CTA组相比，P＜0.05，差异有统计学意义；PES组与CD组相比，P＜0.05，差异有统计学意义；而CTA组与CD组相比，P＞0.05，差异无统计学意义。 3ESRD患者颈总动脉IMT增厚比率（66.7%）显著高于健康对照组（15%），且有斑块患者血ADMA水平（1.21±0.14）umol/L明显高于无斑块者（0.77±0.15）umol/L，P＜0.05，差异有统计学意义。相关分析显示：ADMA与IMT显著正相关（r=0.997，P＜0.05）。多元逐步回归分析显示ADMA、MABP（r=0.587，P＜0.05）与ESRD患者颈总动脉IMT独立相关，回归方程为Y=-0.38+1.631XADMA。 4ESRD组患者LVMI（119.79±15.46）g/m2高于健康对照组（100.26±11.46）g/m2，且左室肥厚组患者血清ADMA水平（1.13±0.19）umol/L明显高于非肥厚组（0.73±0.14）umol/L，P＜0.05，差异有统计学意义。相关分析显示：血清ADMA水平与LVMI呈正相关（r=0.869，P＜0.05）。多元逐步回归分析显示ADMA、MABP（r=0.592，P＜0.05）、透龄（r=-0.385，P＜0.05）与ESRD患者颈总动脉LVMI独立相关，回归方程为Y=-0.38+1.631XADMA。ESRD组患者LVEF水平（61.51±6.5）%明显低于健康对照组（64.12±3.83）%，相关分析显示：ADMA与LVEF显著负相关（r=-0.848，P＜0.05）。 结论： 1ESRD患者血ADMA水平高于健康人群。 2可以认为高通量合成膜透析器单次清除血ADMA的能力优于高通量纤维素膜透析器和低通量纤维素膜透析器；尚不能认为高通量纤维素膜透析器单次清除血ADMA的能力优于低通量纤维素膜透析器。可以认为长期应用高通量合成膜透析器可降低血ADMA水平，尚不能认为长期应用高通量纤维素膜透析器和低通量纤维素膜透析器可降低血ADMA水平。 3可以认为ESRD患者颈动脉粥样硬化发病率高于健康人群，血ADMA水平参与ESRD患者颈动脉粥样硬化的发生发展，可独立预测颈动脉粥样硬化。 4ESRD患者左心室肥厚发生率高于健康人群，血ADMA水平参与ESRD患者左心室肥厚的发生发展，可独立预测左心室肥厚。ESRD患者左心室射血分数低于健康人群，左心室射血能力降低与血ADMA水平升高与有关。
[Abstract]:Objective: AsymmetricDimethylarginine (ADMA), an asymmetric two methyl arginine (ADMA), is a marker of endothelial dysfunction and a risk factor for cardiovascular disease in recent years. Blood ADMA and EndStageRenalDisease (ESRD) patients (Cardiovasculardisea) The relationship between the incidence of Se, CVD) and mortality was associated with the changes in serum ADMA levels in dialysable dialysable dialysate with different fluxes and different membranous dialysate, to evaluate the clearance of ADMA in hemodialysis, and to explore the relationship between the level of blood ADMA and cardiovascular diseases such as atherosclerosis and left ventricular fat thickness.
Methods: from October 2013 to December 2013, 60 ESRD patients with stable hemodialysis in the hemodialysis room of the second hospital of Hebei Medical University were selected, including 31 men and 29 women. The Kt / V value fluctuated from 1.2 to 1.4, and the dialysis time was more than 5 months. All the patients were involved in the dialyzer before the group was BaxterCAHP-150/. 5M2734 (low flux cellulose membrane dialyzer) was randomly divided into low flux cellulose membrane group (group CD), high throughput cellulose membrane group (group CTA) and high flux polysulfone membrane group (group PES), 20 cases in each group. 20 healthy subjects were selected as control group. The age of dialysis and healthy control groups were not different. 3 times a week, 4 hours each time, of which group PES was changed to Polyfluxl7R dialyzer, group CTA was reused with BaxterCT190G/5M1546 dialyzer, group CD continued to use BaxterCAHP-150/5M2734 dialyzer. The three dialyser could be reused. The blood ADMA level of 3 groups of patients before and after single treatment and 3 months after dialysis were detected respectively. The blood ADMA content was measured by enzyme linked immunosorbent assay (ELISA) in the early morning. The basic data of age, sex and age of each group were collected. All the experimental and control groups were sampled at the empty abdomen on the fasting 12h second day morning to determine the low density lipoprotein (LDL-C), total cholesterol (TC), and high density fat Biochemical indexes such as protein (HDL-C). Monitoring hemodialysis patients' blood pressure: before dialysis, 1 hours of dialysis, 2 hours of dialysis, 3 hours of dialysis, blood pressure and mean arterial pressure at the end of dialysis. The PhilipsIE33 ultrasonic diagnostic system was used for echocardiography to record the thickness of ventricular septum (IVST) and the internal diameter of left ventricular end diastolic. LVDd) the thickness of left ventricular posterior wall (LVPWT), left ventricular ejection fraction (LVEF), and repeated measurements of 3 times in different scans. The PhilipsIU22 ultrasonic diagnostic system was used to detect the intima media thickness (IMT) of bilateral common carotid artery (IMT) and the formation of plaque in the healthy control group. The statistical analysis of SPSS16.0 software was used for statistical analysis. There was statistical difference between P < 0.05 and P < 0.01.
Result:
The blood ADMA level in group 1CD, group CTA and group PES was higher than that in healthy control group. The level of ADMA in P < 0.05. healthy control group was 0.34 + 0.14umol/L, and the highest level of ADMA in group CD was 1.23 + 0.15umol/L. The lowest level in CTA group was 0.95. ADMA was positively correlated with MABP (r=0.583, P < 0.05) and negatively correlated with Hb (r=-0.316, P < 0.05).
The blood ADMA level of group 2PES was 0.66 + 0.09umol/L before treatment, 0.23 + 0.07umol/L and P < 0.01 after treatment. The serum ADMA level was 0.95 + 0.11umol/L before treatment, 0.70 + 0.12umol/L and P < 0.01 after treatment. The blood ADMA level was 1.23 + before treatment and 0.97 + 0.01 after treatment. The difference between the three treatments before and after the three treatments was compared to P < 0.05, the difference was statistically significant between the.PES group and the CTA group, and the difference was statistically significant. The difference was statistically significant between the PES group and the CD group, P < 0.05, and the CTA group compared with the CD group, P > 0.05, and the difference was 0.31 + after 3 months after the.PES group. Mol/L, lower than 3 months ago, P < 0.01, the difference was significant. The blood ADMA level in group CTA was 0.93 + 0.12umol/L after 3 months of treatment, no significant difference compared with 3 months ago, P > 0.05. The serum ADMA level was 1.21 + 0.17umol/L after 3 months in the CD group, and there was no significant difference compared with 3 months ago, P > 0.05. three treatment after 3 months, ADMA difference comparison, 0 .01, the difference significant.PES group compared with the CTA group, P < 0.05, the difference was statistically significant, PES group compared with the CD group, P < 0.05, the difference was statistically significant, while CTA group and CD group, P > 0.05, the difference was not statistically significant.
The IMT thickening ratio of the common carotid artery in 3ESRD patients (66.7%) was significantly higher than that in the healthy control group (15%), and the blood ADMA level of the plaque patients (1.21 + 0.14) umol/L was significantly higher than that of the non plaques (0.77 + 0.15) umol/L, P < 0.05, the difference was statistically significant. The correlation analysis showed that ADMA and IMT were significantly positive correlation (r=0.997, P < 0.05). Multivariate stepwise regression analysis showed that ADMA, MABP (r=0.587, P < 0.05) were independently correlated with IMT of ESRD in patients with ESRD, and the regression equation was Y=-0.38+1.631XADMA..
In group 4ESRD, the LVMI (119.79 + 15.46) g/m2 was higher than that of the healthy control group (100.26 + 11.46) g/m2, and the serum ADMA level (1.13 + 0.19) umol/L in the left ventricular hypertrophy group was significantly higher than that of the non hypertrophic group (0.73 + 0.14) umol/L, P < 0.05, the difference was statistically significant. The correlation analysis showed that the serum ADMA level was positively correlated with LVMI (r=0.869, P < 0.05). Multivariate phase. The stepwise regression analysis showed that ADMA, MABP (r=0.592, P < 0.05), r=-0.385, P < 0.05) were independent of LVMI in the common carotid artery of ESRD patients. The regression equation was the LVEF level of the Y=-0.38+1.631XADMA.ESRD group (61.51 + 6.5)% lower than that of the healthy control group (64.12 + 3.83)%. The correlation analysis showed that ADMA was negatively correlated with LVEF (0.05).
Conclusion:
The level of blood ADMA in patients with 1ESRD was higher than that in healthy people.
2 it can be considered that the ability of high flux synthetic membrane dialyzer to scavenging blood ADMA is better than high flux cellulose membrane dialyzer and low flux cellulose membrane dialyzer. It is not still believed that the ability of high flux cellulose membrane dialyzer to clean blood ADMA is better than low flux cellulose membrane dialyzer. Long-term use of high-flux cellulose membrane dialyzers and low-flux cellulose membrane dialyzers can reduce the level of ADMA.
3 it is considered that the incidence of carotid atherosclerosis in patients with ESRD is higher than that in healthy people. The level of blood ADMA is involved in the development of carotid atherosclerosis in ESRD patients and can be independently predicted for carotid atherosclerosis.
The incidence of left ventricular hypertrophy in 4ESRD patients is higher than that in healthy people. The level of blood ADMA is involved in the development of left ventricular hypertrophy in ESRD patients. The left ventricular ejection fraction of left ventricular hypertrophy patients can be independently predicted. The left ventricular ejection fraction is lower than that of the healthy people. The decrease of left ventricular ejection ability and the increase of blood ADMA level are related to the incidence of left ventricular hypertrophy in.ESRD patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5;R54
本文编号：2166871
[Abstract]:Objective: AsymmetricDimethylarginine (ADMA), an asymmetric two methyl arginine (ADMA), is a marker of endothelial dysfunction and a risk factor for cardiovascular disease in recent years. Blood ADMA and EndStageRenalDisease (ESRD) patients (Cardiovasculardisea) The relationship between the incidence of Se, CVD) and mortality was associated with the changes in serum ADMA levels in dialysable dialysable dialysate with different fluxes and different membranous dialysate, to evaluate the clearance of ADMA in hemodialysis, and to explore the relationship between the level of blood ADMA and cardiovascular diseases such as atherosclerosis and left ventricular fat thickness.
Methods: from October 2013 to December 2013, 60 ESRD patients with stable hemodialysis in the hemodialysis room of the second hospital of Hebei Medical University were selected, including 31 men and 29 women. The Kt / V value fluctuated from 1.2 to 1.4, and the dialysis time was more than 5 months. All the patients were involved in the dialyzer before the group was BaxterCAHP-150/. 5M2734 (low flux cellulose membrane dialyzer) was randomly divided into low flux cellulose membrane group (group CD), high throughput cellulose membrane group (group CTA) and high flux polysulfone membrane group (group PES), 20 cases in each group. 20 healthy subjects were selected as control group. The age of dialysis and healthy control groups were not different. 3 times a week, 4 hours each time, of which group PES was changed to Polyfluxl7R dialyzer, group CTA was reused with BaxterCT190G/5M1546 dialyzer, group CD continued to use BaxterCAHP-150/5M2734 dialyzer. The three dialyser could be reused. The blood ADMA level of 3 groups of patients before and after single treatment and 3 months after dialysis were detected respectively. The blood ADMA content was measured by enzyme linked immunosorbent assay (ELISA) in the early morning. The basic data of age, sex and age of each group were collected. All the experimental and control groups were sampled at the empty abdomen on the fasting 12h second day morning to determine the low density lipoprotein (LDL-C), total cholesterol (TC), and high density fat Biochemical indexes such as protein (HDL-C). Monitoring hemodialysis patients' blood pressure: before dialysis, 1 hours of dialysis, 2 hours of dialysis, 3 hours of dialysis, blood pressure and mean arterial pressure at the end of dialysis. The PhilipsIE33 ultrasonic diagnostic system was used for echocardiography to record the thickness of ventricular septum (IVST) and the internal diameter of left ventricular end diastolic. LVDd) the thickness of left ventricular posterior wall (LVPWT), left ventricular ejection fraction (LVEF), and repeated measurements of 3 times in different scans. The PhilipsIU22 ultrasonic diagnostic system was used to detect the intima media thickness (IMT) of bilateral common carotid artery (IMT) and the formation of plaque in the healthy control group. The statistical analysis of SPSS16.0 software was used for statistical analysis. There was statistical difference between P < 0.05 and P < 0.01.
Result:
The blood ADMA level in group 1CD, group CTA and group PES was higher than that in healthy control group. The level of ADMA in P < 0.05. healthy control group was 0.34 + 0.14umol/L, and the highest level of ADMA in group CD was 1.23 + 0.15umol/L. The lowest level in CTA group was 0.95. ADMA was positively correlated with MABP (r=0.583, P < 0.05) and negatively correlated with Hb (r=-0.316, P < 0.05).
The blood ADMA level of group 2PES was 0.66 + 0.09umol/L before treatment, 0.23 + 0.07umol/L and P < 0.01 after treatment. The serum ADMA level was 0.95 + 0.11umol/L before treatment, 0.70 + 0.12umol/L and P < 0.01 after treatment. The blood ADMA level was 1.23 + before treatment and 0.97 + 0.01 after treatment. The difference between the three treatments before and after the three treatments was compared to P < 0.05, the difference was statistically significant between the.PES group and the CTA group, and the difference was statistically significant. The difference was statistically significant between the PES group and the CD group, P < 0.05, and the CTA group compared with the CD group, P > 0.05, and the difference was 0.31 + after 3 months after the.PES group. Mol/L, lower than 3 months ago, P < 0.01, the difference was significant. The blood ADMA level in group CTA was 0.93 + 0.12umol/L after 3 months of treatment, no significant difference compared with 3 months ago, P > 0.05. The serum ADMA level was 1.21 + 0.17umol/L after 3 months in the CD group, and there was no significant difference compared with 3 months ago, P > 0.05. three treatment after 3 months, ADMA difference comparison, 0 .01, the difference significant.PES group compared with the CTA group, P < 0.05, the difference was statistically significant, PES group compared with the CD group, P < 0.05, the difference was statistically significant, while CTA group and CD group, P > 0.05, the difference was not statistically significant.
The IMT thickening ratio of the common carotid artery in 3ESRD patients (66.7%) was significantly higher than that in the healthy control group (15%), and the blood ADMA level of the plaque patients (1.21 + 0.14) umol/L was significantly higher than that of the non plaques (0.77 + 0.15) umol/L, P < 0.05, the difference was statistically significant. The correlation analysis showed that ADMA and IMT were significantly positive correlation (r=0.997, P < 0.05). Multivariate stepwise regression analysis showed that ADMA, MABP (r=0.587, P < 0.05) were independently correlated with IMT of ESRD in patients with ESRD, and the regression equation was Y=-0.38+1.631XADMA..
In group 4ESRD, the LVMI (119.79 + 15.46) g/m2 was higher than that of the healthy control group (100.26 + 11.46) g/m2, and the serum ADMA level (1.13 + 0.19) umol/L in the left ventricular hypertrophy group was significantly higher than that of the non hypertrophic group (0.73 + 0.14) umol/L, P < 0.05, the difference was statistically significant. The correlation analysis showed that the serum ADMA level was positively correlated with LVMI (r=0.869, P < 0.05). Multivariate phase. The stepwise regression analysis showed that ADMA, MABP (r=0.592, P < 0.05), r=-0.385, P < 0.05) were independent of LVMI in the common carotid artery of ESRD patients. The regression equation was the LVEF level of the Y=-0.38+1.631XADMA.ESRD group (61.51 + 6.5)% lower than that of the healthy control group (64.12 + 3.83)%. The correlation analysis showed that ADMA was negatively correlated with LVEF (0.05).
Conclusion:
The level of blood ADMA in patients with 1ESRD was higher than that in healthy people.
2 it can be considered that the ability of high flux synthetic membrane dialyzer to scavenging blood ADMA is better than high flux cellulose membrane dialyzer and low flux cellulose membrane dialyzer. It is not still believed that the ability of high flux cellulose membrane dialyzer to clean blood ADMA is better than low flux cellulose membrane dialyzer. Long-term use of high-flux cellulose membrane dialyzers and low-flux cellulose membrane dialyzers can reduce the level of ADMA.
3 it is considered that the incidence of carotid atherosclerosis in patients with ESRD is higher than that in healthy people. The level of blood ADMA is involved in the development of carotid atherosclerosis in ESRD patients and can be independently predicted for carotid atherosclerosis.
The incidence of left ventricular hypertrophy in 4ESRD patients is higher than that in healthy people. The level of blood ADMA is involved in the development of left ventricular hypertrophy in ESRD patients. The left ventricular ejection fraction of left ventricular hypertrophy patients can be independently predicted. The left ventricular ejection fraction is lower than that of the healthy people. The decrease of left ventricular ejection ability and the increase of blood ADMA level are related to the incidence of left ventricular hypertrophy in.ESRD patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5;R54
【引证文献】
相关硕士学位论文 前1条
1 鲁宁宁;年产1000万支血液透析用透析器的工厂创建与设计[D];大连工业大学;2015年
本文编号：2166871
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