摘要
目的:分析维持性血液透析(maintenance hemodialysis,MHD)患者β2微球蛋白(β2-microglobulin,β2-MG)和脂蛋白(a)[Lp(a)]与左室结构和功能的关系。方法:选取2017年1月至2019年6月在山东第一医科大学附属青岛医院血液净化中心行规律血液透析治疗的89例MHD患者作为研究对象。收集患者的临床资料进行回顾性分析。根据左室后壁厚度(left ventricular wall,LVPWT)和室间隔厚度(interventricular septum thickness,IVST)同时≥12 mm作为诊断左室肥厚(LVH)的标准,将受试对象分为左室肥厚组(n=43)和非左室肥厚组(n=46)。化学发光法检测血β2-MG;免疫比浊法检测血Lp(a);飞利浦iu22超声诊断仪评定心脏形态、结构和功能。结果:左室肥厚组与非左室肥厚组MHD患者性别、年龄、透析龄、透析1 h收缩压、透析1 h舒张压、尿素下降率比较差异均无统计学意义(P>0.05)。左室肥厚组患者血β2-MG、Lp(a)、C反应蛋白均高于非左室肥厚组(P<0.05)。左室肥厚组患者左房内径、IVST和LVPWT均升高,而左室射血分数(LVEF)下降(P<0.05)。相关性分析显示:β2-MG与血尿酸(r=-0.382,P=0.000)呈负相关,与LVPWT(r=0.251,P=0.018)呈正相关;Lp(a)与甲状旁腺素(r=-0.218,P=0.040)呈负相关,与白蛋白(r=0.270,P=0.010)、IVST(r=0.228,P=0.032)、LVPWT(r=0.292,P=0.006)呈正相关。多元线性逐步回归分析显示:β2-MG(β=-0.038,P=0.045)、C反应蛋白(β=-0.078,P=0.000)是左室肥厚的独立危险因素。结论:MHD患者血β2-MG、Lp(a)与左室结构和功能改变密切相关。
Objective:To investigate the association between serumβ2-microglobulin(β2-MG)and lipoprotein(a)[Lp(a)]and left ventricular structure and function in maintenance hemodialysis(MHD)patients.Methods:Totally 89 MHD in Blood Purification Center of the Affiliated Qingdao Hospital of Shandong First Medical University from January 2017 to June 2019 were selected.Their clinical data were collected to conduct retrospectively analysis.Left ventricular hypertrophy(LVH)was diagnosed when left ventricular wall thickness(LVPWT)and interventricular septum thickness(IVST)≥12 mm.The subjects were divided into the LVH group(n=43)and the non-LVH group(n=46).β2-MG was detected by chemiluminescence.Lp(a)was measured by turbidimetric inhibition immuno assay.Cardiac shape,structure and function were assessed by two dimensional echocardiography.Results:No statistical significance was attained in gender,age,dialysis age,dialysis 1 h systolic pressure,dialysis 1 h diastolic pressure and urea reduction rate between the two groups of patients on hemodialysis(P>0.05).β2-MG,Lp(a)and C reactive protein in the patients of the LVH group were significantly higher than those of the non-LVH group(P<0.05).The left atrial diameter(LA),IVST and LVPWT were significantly higher while the left ventricular ejection fraction(LVEF)was significantly lower in patients of the LVH group(P<0.05).Correlation study revealed thatβ2-MG was negatively correlated with serum uric acid(r=-0.382,P=0.000)and positively correlated with LVPWT(r=0.251,P=0.018).Lp(a)was negatively correlated with parathyroid hormone(r=-0.218,P=0.040)and positively correlated with albumin(r=0.270,P=0.010),IVST(r=0.228,P=0.032)and LVPWT(r=0.292,P=0.006).Multivariate regression analysis results showed thatβ2-MG(β=-0.038,P=0.045)and C reactive protein(β=-0.078,P=0.000)were independent risk factors for left ventricular hypertrophy.Conclusion:Serumβ2-MG and Lp(a)are closely related to left ventricular structure and function changes in MHD patients.
作者
姚丹丹
任直亲
仇方忻
YAO Dandan;REN Zhiqin;QIU Fangxin(Department of Nephrology,the Affiliated Qingdao Hospital of Shandong First Medical University,Shandong Qingdao 266109,China;Department of Nephrology and Rheumatology,Qingdao Jiaozhou Central Hospital,Shandong Qingdao 266300,China)
出处
《中国医药导刊》
2020年第1期1-5,共5页
Chinese Journal of Medicinal Guide
基金
青岛市城阳区民生引导计划项目(项目编号:2018-23-09,项目名称:慢性肾脏病患者血清尿酸与骨代谢及骨密度的关系)。
