血液透析對血ADMA水平的影響及其與心血管并發(fā)癥關(guān)系的研究
發(fā)布時間：2018-08-05 20:04
【摘要】：目的：近年來學(xué)者們逐漸認識并高度重視的不對稱性二甲基精氨酸(AsymmetricDimethylarginine，ADMA)是內(nèi)皮功能損傷的標(biāo)記物，也是心血管疾病發(fā)生的危險因子。血ADMA水平與終末期腎臟�。‥ndStageRenalDisease，ESRD)患者心血管疾病（Cardiovasculardisease，CVD）的發(fā)病率和死亡率相關(guān)。本研究通過測定ESRD患者采用不同通量、不同膜質(zhì)的透析器透析血清ADMA水平的變化，評價血液透析對血ADMA的清除能力，探討血ADMA水平與動脈粥樣硬化及左心室肥厚等心血管疾病的關(guān)系。 方法：選擇2013年10月到2013年12月于河北醫(yī)科大學(xué)第二醫(yī)院血液透析室行規(guī)律血液透析的病情穩(wěn)定的ESRD患者60例，其中男31例，女29例，Kt／V值波動于1．2～1．4，已透析時間均大于5個月。所有患者參與分組前所應(yīng)用透析器均為BaxterCAHP-150/5M2734(低通量纖維素膜透析器）。隨機分為低通量纖維素膜組(CD組)、高通量纖維素膜組（CTA組）和高通量聚砜膜組(PES組)，每組各20例。選取20例體檢健康者作為對照組。經(jīng)統(tǒng)計學(xué)分析，各透析組及健康對照組年齡、性別構(gòu)成均無差別。透析患者每周透析3次，每次4小時，其中PES組改用Polyfluxl7R透析器，CTA組改用BaxterCT190G/5M1546透析器，CD組繼續(xù)應(yīng)用BaxterCAHP-150/5M2734透析器。三種透析器均可重復(fù)使用。分別檢測3組患者單次治療前后及透析3個月后的血ADMA水平。抽取健康對照組人員的清晨空腹肘靜脈血標(biāo)本。采用酶聯(lián)免疫吸附法（ELISA）測定各組的血ADMA含量。收集各組的年齡、性別、透齡等基本資料。所有實驗組和對照組患者均在空腹12h后于第二天清晨空腹抽取靜脈血以測定低密度脂蛋白(LDL-C)、總膽固醇(TC)、高密度脂蛋白(HDL-C)等生化指標(biāo)。監(jiān)測透析病人血壓：測量透析前、透析1小時、透析2小時、透析3小時和透析結(jié)束時的血壓并計算平均動脈壓。采用PhilipsIE33超聲診斷系統(tǒng)進行心臟超聲檢查，記錄心動周期末期室間隔厚度（IVST）、左室舒張末期的內(nèi)徑（LVDd）、左室后壁的厚度（LVPWT）、左心室射血分?jǐn)?shù)（LVEF），在不同掃描中重復(fù)測量3次取平均值。采用PhilipsIU22超聲診斷系統(tǒng)探測各組透析病人及健康對照組雙側(cè)頸總動脈內(nèi)膜-中層厚度（IMT）、有無斑塊形成等。采用SPSS16.0統(tǒng)計軟件包行統(tǒng)計學(xué)分析，，認為P＜0.05有統(tǒng)計學(xué)差異，P＜0.01差異顯著。 結(jié)果： 1CD組、CTA組、PES組患者血ADMA水平較健康對照組升高，P＜0.05。健康對照組血ADMA水平為0.34±0.14umol/L，CD組血ADMA水平最高為1.23±0.15umol/L，CTA組居中0.95±0.11umol/L，PES組水平最低為0.66±0.09umol/L。ESRD患者血ADMA水平與常規(guī)指標(biāo)的Pearson相關(guān)分析顯示：ADMA與MABP(r=0.583，P＜0.05)呈正相關(guān)，與Hb(r=-0.316，P＜0.05)呈負相關(guān)。 2PES組患者治療前血ADMA水平為0.66±0.09umol/L，治療后為0.23±0.07umol/L，P＜0.01，差異顯著；CTA組治療前血ADMA水平為0.95±0.11umol/L，治療后為0.70±0.12umol/L，P＜0.01，差異顯著；CD組治療前血ADMA水平為1.23±0.15umol/L，治療后為0.97±0.09umol/L，P＜0.01，差異顯著。三種治療前后ADMA差值相比P＜0.05，差異有統(tǒng)計學(xué)意義。PES組與CTA組相比P＜0.05，差異有統(tǒng)計學(xué)意義；PES組與CD組相比，P＜0.05，差異有統(tǒng)計學(xué)意義；而CTA組與CD組相比，P＞0.05，差異無統(tǒng)計學(xué)意義。PES組治療3個月后血ADMA水平為0.31±0.11umol/L，比3個月前有所下降，P＜0.01，差異顯著；CTA組治療3個月后血ADMA水平為0.93±0.12umol/L，與3個月前相比無明顯差別，P＞0.05；CD組治療3個月后血ADMA水平為1.21±0.17umol/L，與3個月前相比無明顯差別，P＞0.05。三種治療3個月后ADMA差值比較，P＜0.01，差異顯著。PES組與CTA組相比，P＜0.05，差異有統(tǒng)計學(xué)意義；PES組與CD組相比，P＜0.05，差異有統(tǒng)計學(xué)意義；而CTA組與CD組相比，P＞0.05，差異無統(tǒng)計學(xué)意義。 3ESRD患者頸總動脈IMT增厚比率（66.7%）顯著高于健康對照組（15%），且有斑塊患者血ADMA水平（1.21±0.14）umol/L明顯高于無斑塊者（0.77±0.15）umol/L，P＜0.05，差異有統(tǒng)計學(xué)意義。相關(guān)分析顯示：ADMA與IMT顯著正相關(guān)（r=0.997，P＜0.05）。多元逐步回歸分析顯示ADMA、MABP（r=0.587，P＜0.05）與ESRD患者頸總動脈IMT獨立相關(guān)，回歸方程為Y=-0.38+1.631XADMA。 4ESRD組患者LVMI（119.79±15.46）g/m2高于健康對照組（100.26±11.46）g/m2，且左室肥厚組患者血清ADMA水平（1.13±0.19）umol/L明顯高于非肥厚組（0.73±0.14）umol/L，P＜0.05，差異有統(tǒng)計學(xué)意義。相關(guān)分析顯示：血清ADMA水平與LVMI呈正相關(guān)（r=0.869，P＜0.05）。多元逐步回歸分析顯示ADMA、MABP（r=0.592，P＜0.05）、透齡（r=-0.385，P＜0.05）與ESRD患者頸總動脈LVMI獨立相關(guān)，回歸方程為Y=-0.38+1.631XADMA。ESRD組患者LVEF水平（61.51±6.5）%明顯低于健康對照組（64.12±3.83）%，相關(guān)分析顯示：ADMA與LVEF顯著負相關(guān)（r=-0.848，P＜0.05）。 結(jié)論： 1ESRD患者血ADMA水平高于健康人群。 2可以認為高通量合成膜透析器單次清除血ADMA的能力優(yōu)于高通量纖維素膜透析器和低通量纖維素膜透析器；尚不能認為高通量纖維素膜透析器單次清除血ADMA的能力優(yōu)于低通量纖維素膜透析器�？梢哉J為長期應(yīng)用高通量合成膜透析器可降低血ADMA水平，尚不能認為長期應(yīng)用高通量纖維素膜透析器和低通量纖維素膜透析器可降低血ADMA水平。 3可以認為ESRD患者頸動脈粥樣硬化發(fā)病率高于健康人群，血ADMA水平參與ESRD患者頸動脈粥樣硬化的發(fā)生發(fā)展，可獨立預(yù)測頸動脈粥樣硬化。 4ESRD患者左心室肥厚發(fā)生率高于健康人群，血ADMA水平參與ESRD患者左心室肥厚的發(fā)生發(fā)展，可獨立預(yù)測左心室肥厚。ESRD患者左心室射血分?jǐn)?shù)低于健康人群，左心室射血能力降低與血ADMA水平升高與有關(guān)。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692.5;R54
本文編號：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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692.5;R54
【引證文獻】
相關(guān)碩士學(xué)位論文 前1條
1 魯寧寧;年產(chǎn)1000萬支血液透析用透析器的工廠創(chuàng)建與設(shè)計[D];大連工業(yè)大學(xué);2015年
本文編號：2166871
本文鏈接：http://sikaile.net/yixuelunwen/mjlw/2166871.html
最近更新
教材專著
