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目的探讨血液透析(HD)患者血浆不对称性二甲基精氨酸(ADMA)浓度与颈动脉粥样硬化程度的关系。方法采用酶联免疫法(ELISA)检测2006年1月至2007年6月首都医科大学附属北京朝阳医院肾内科透析中心HD患者69例和年龄匹配的健康对照35名血浆ADMA浓度;彩色多普勒超声检测患者颈动脉内膜-中层厚度(IMT)及粥样硬化斑块情况,同时测定血流动力学参数。将HD患者分为颈动脉正常组、IMT增厚组和颈动脉斑块组后,并进行相关性分析。结果 HD患者血浆ADMA浓度[(1.17±0.38)μmol/L]明显高于对照组[(0.42±0.15)μmol/L]。颈动脉斑块组血浆ADMA浓度明显高于IMT增厚组和颈动脉正常组,分别为(1.53±0.48)μmol/L、(1.21±0.35)μmol/L和(1.07±0.42)μmol/L(P<0.05)。HD患者平均IMT值、颈动脉粥样斑块检出率和颈总动脉血流动力学指标均明显高于年龄匹配的对照组(P<0.05)。多因素逐步回归分析显示,影响颈总动脉IMT的因素按影响程度依次为血浆ADMA、年龄、透析时间和总胆固醇(TC)。结论 HD患者动脉粥样硬化病变与血浆ADMA浓度有关,HD患者血浆ADMA在颈动脉粥样硬化的发生和发展中起重要作用。
Objective To investigate the relationship between plasma asymmetric dimethylarginine (ADMA) and carotid atherosclerosis in hemodialysis (HD) patients. Methods The plasma ADMA concentrations in 69 HD patients and age-matched healthy controls from January 2006 to June 2007 in Beijing Chaoyang Hospital of Capital Medical University from January 2006 to June 2007 were determined. Color Doppler echocardiography The carotid artery intima-media thickness (IMT) and atherosclerotic plaque were detected by ultrasound, and the hemodynamic parameters were also measured. HD patients were divided into normal carotid artery group, IMT thickening group and carotid artery plaque group, and the correlation analysis. Results The plasma ADMA concentration in HD patients [(1.17 ± 0.38) μmol / L] was significantly higher than that in the control group [(0.42 ± 0.15) μmol / L]. The levels of plasma ADMA in carotid plaque group were significantly higher than those in normal IMT group and normal carotid artery group (1.53 ± 0.48) μmol / L, (1.21 ± 0.35) μmol / L and (1.07 ± 0.42) μmol / L P <0.05). The mean IMT, carotid artery plaque detection rate and common carotid artery hemodynamic parameters in HD patients were significantly higher than those in the age-matched control group (P <0.05). Multivariate stepwise regression analysis showed that the factors influencing the common carotid artery IMT were as follows: plasma ADMA, age, dialysis time and total cholesterol (TC). Conclusion The atherosclerotic lesions in HD patients are related to the concentration of ADMA in plasma. ADMA in plasma of HD patients plays an important role in the occurrence and development of carotid atherosclerosis.