【摘要】：目的： 探討維持性血液透析患者血清尿素氮（UREA）、血清肌酐（CREA）、血清Hcy、血清NO、血清ADMA五項指標的變化，評價血液透析對尿毒癥患者血清Hcy、血清NO、血清ADMA的影響以及他們之間的相關性。 方法： 1研究對象 1.1對照組：我院健康查體者22例，其中男性13例，女性9例，年齡25-73歲，平均年齡47.95±16.27。 1.2尿毒癥期非透析組：患者22例，為2011年3月-2012年3月在河北醫(yī)科大學第二醫(yī)院血液透析科住院治療的患者，其中男性12例，女性10例，年齡23-76歲，平均年齡45.54±15.51歲。 1.3慢性腎功能不全尿毒癥期維持性血液透析組：共22例。均在河北醫(yī)科大學第二醫(yī)院血液透析科診斷為尿毒癥并建立血管通路后行血液透析治療。透析時間3個月。其中男性11例，女性11例，年齡22-78歲,平均年齡48.77±18.45歲。 2觀察指標：患者的姓名、性別、年齡、身高、體重、病程、血液透析時間、超濾量、血壓、心率、原發(fā)病、尿量、血清尿素氮(UREA)、血清肌酐(CREA)、血清Hcy、NO、ADMA等。 結果： 1三組間年齡、性別一般情況分析：三組間年齡、性別構成無差異。 2三組間腎功能分析：對照組血清UREA水平為5.19±0.95mmol/L，血清CREA水平為83.95±12.74μmol/L，血清β2MG水平為1.34±0.62μmol/L；尿毒癥組血清UREA水平為24.85±6.23mmol/L，血清CREA水平為798.59±214.56μmol/L，血清β2MG水平為14.54±4.12μmol/L；血液透析組透析前血清UREA水平為28.57±7.67mmol/L，血清CREA水平為898.50±243.90μmol/L，血清β2MG水平為16.58±3.60μmol/L；血液透析組透析后血清UREA水平為10.46±4.06mmol/L，血清CREA水平為405.39±142.07μmol/L，血清β2MG水平為15.70±2.23μmol/L。進行統(tǒng)計學分析后，尿毒癥組、血液透析組透析前、血液透析組透析后血清UREA、CREA、β2MG均高于對照組（P0.01）；血液透析組透析前血清UREA（P0.05）、CREA（P0.01）、β2MG（P0.05）均高于尿毒癥組；血液透析組透析后血清UREA、CREA均低于透析前（P0.01）。 3三組間血清Hcy、血清NO和血清ADMA水平的比較:對照組血清Hcy水平為8.21±1.55μmol/L，血清NO水平為45.97±13.36μmol/L，血清AMDA水平為0.34±0.14μmol/L；尿毒癥組血清Hcy水平為45.57±14.40μmol/L，血清NO水平為151.37±54.70μmol/L，血清AMDA水平為0.89±0.18μmol/L；血液透析組透析前血清Hcy水平為30.80±2.36μmol/L，血清NO水平為144.12±76.72μmol/L，血清AMDA水平為0.89±0.24μmol/L；血液透析組透析后血清Hcy水平為19.31±1.63μmol/L，血清NO水平為59.97±27.61μmol/L，血清AMDA水平為0.60±0.39μmol/L。進行統(tǒng)計學分析后，尿毒癥組、血液透析組透析前、血液透析組透析后血清Hcy、NO、ADMA均高于對照組（P0.01）；血液透析組透析前血清Hcy、ADMA低于尿毒癥組（P0.05）；血液透析組透析前血清NO低于尿毒癥組（P0.05）；血液透析組透析后血清Hcy、NO、ADMA均低于透析前（P0.01）。 4血清Hcy與年齡、血清NO、血清ADMA在對照組、尿毒癥組、血液透析組的相關性分析：對照組血清Hcy與年齡（r=-0.06，P0.05）、血清NO（r=-0.33，P0.05）無相關性，與血清ADMA成正相關關系（r=0.62，P0.01）；尿毒癥組血清Hcy與年齡（r=0.23，P0.05）、血清NO（r=0.18，P0.05）無相關性，與血清ADMA成正相關關系（r=0.79，，P0.01）。血液透析組血清Hcy與年齡（r=-0.13，P0.05）、血清NO（r=-0.10，P0.05）無相關性，與血清ADMA成正相關關系（r=0.50，P0.05）。 5尿毒癥組病人血清NO和血清肌酐、血清尿素氮相關性分析：尿毒癥組血清NO和血清肌酐相關（r=0.82，P0.01），尿毒癥組血清NO和血清尿素氮相關（r=0.89，P0.01）。 結論： 1尿毒癥患者血清Hcy、血清ADMA比正常人群升高，是CVD并發(fā)癥的重要危險因素。 2血液透析可部分清除血清Hcy、ADMA，來改善血管內皮功能，有利于CKD患者CVD并發(fā)癥的防治。 3ESRD患者血清Hcy和血清ADMA相關。 4尿毒癥患者血清NO比正常人群升高，可能與內皮功能紊亂、炎癥等因素有關。
[Abstract]:Objective:
Objective To investigate the changes of serum urea nitrogen (UREA), serum creatinine (CREA), serum Hcy, serum NO and serum ADMA in maintenance hemodialysis patients, and to evaluate the effects of hemodialysis on serum Hcy, serum NO and serum ADMA in uremia patients and their correlation.
Method:
1 object of study
1.1 Control group: There were 22 cases of physical examination in our hospital, including 13 males and 9 females, aged 25-73 years, with an average age of 47.95+16.27.
1.2 Non-dialysis group in uremic stage: 22 patients were hospitalized in the Department of Hemodialysis of the Second Hospital of Hebei Medical University from March 2011 to March 2012. There were 12 males and 10 females, aged 23-76 years, with an average age of 45.54 (+ 15.51).
1.3 Maintenance hemodialysis group of 22 patients with chronic renal insufficiency in uremia stage were treated with hemodialysis after diagnosis of uremia and establishment of vascular access in the Department of Hemodialysis of the Second Hospital of Hebei Medical University.
2 Observation Indicators: Name, sex, age, height, weight, duration of disease, hemodialysis time, ultrafiltration volume, blood pressure, heart rate, primary disease, urine volume, serum urea nitrogen (UREA), serum creatinine (CREA), serum Hcy, NO, ADMA, etc.
Result:
1 there was no difference in age and sex between the three groups: there was no difference in age and sex between the three groups.
Renal function analysis among the three groups: serum UREA level in control group was 5.19 (+ 0.95) mmol/L, serum CREA level was 83.95 (+ 12.74) mmol/L, serum beta-2MG level was 1.34 (+ 0.62) mmol/L, serum UREA level was 24.85 (+ 6.23) mmol/L, serum CREA level was 798.59 (+ 214.56) mmol/L, serum beta-2MG level was 14.54 (+ 4.12) mmol/L in hemodialysis group. Before hemodialysis, serum UREA level was 28.57 [7.67] mmol/L, serum CREA level was 898.50 [243.90] micromol/L, serum beta-2MG level was 16.58 [3.60] micromol/L; after hemodialysis, serum UREA level was 10.46 [4.06] mmol/L, serum CREA level was 405.39 [142.07] micromol/L, serum beta-2MG level was 15.70 [2.23] micromol/L. Before hemodialysis, serum UREA, CREA, and beta 2MG in hemodialysis group were higher than those in control group (P 0.01); before hemodialysis, serum UREA (P 0.05), CREA (P 0.01), and beta 2MG (P 0.05) in hemodialysis group were higher than those in uremia group; after hemodialysis, serum UREA and CREA were lower than those before hemodialysis (P 0.01).
Comparison of serum Hcy, NO and ADMA levels among the three groups: serum Hcy, NO and AMDA levels in the control group were 8.21 The levels of serum Hcy, NO, AMDA, and Hcy were 30.80 (+ 2.36) and 0.89 (+ 0.24) and 59.97 (+ 27.61) and 0.60 (+ 0.39) respectively before and after hemodialysis. After dialysis, the levels of Hcy, NO and ADMA in hemodialysis group were higher than those in control group (P 0.01), Hcy and ADMA in pre-dialysis group were lower than those in uremia group (P 0.05), NO in pre-dialysis group was lower than that in uremia group (P 0.05), and Hcy, NO and ADMA in post-dialysis group were lower than those in pre-dialysis group (P 0.05). (P0.01).
Serum Hcy and age, serum NO, serum ADMA in the control group, uremia group, hemodialysis group correlation analysis: control group serum Hcy and age (r = - 0.06, P 0.05), serum NO (r = - 0.33, P 0.05) no correlation, and serum ADMA was positively correlated (r = 0.62, P 0.01); uremia group serum Hcy and age (r = 0.23, P 0.05), serum NO (r = 0.18, P 0.05) no correlation. There was no correlation between serum Hcy and age (r = - 0.13, P 0.05), serum NO (r = - 0.10, P 0.05), but positive correlation with serum ADMA (r = 0.50, P 0.05).
5 Correlation analysis of serum NO and serum creatinine, serum urea nitrogen in uremia group: serum NO and serum creatinine in uremia group were correlated (r=0.82, P 0.01), serum NO and serum urea nitrogen in uremia group were correlated (r=0.89, P 0.01).
Conclusion:
1 serum Hcy and serum ADMA in uremic patients were higher than those in the normal population, which is an important risk factor for CVD complications.
Hemodialysis can partly remove serum Hcy and ADMA to improve vascular endothelial function, which is conducive to the prevention and treatment of CVD complications in patients with CKD.
Serum Hcy was correlated with serum ADMA in 3ESRD patients.
4 the serum NO of uremic patients is higher than that of the normal population, which may be related to endothelial dysfunction, inflammation and other factors.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692.5

【引證文獻】

相關期刊論文 前1條

1 鄒麗娥;鐘鄭新;王春鳳;廖偉群;;高通量透析對尿毒癥維持性血液透析患者血清HCY、β_2-MG、CysC的影響[J];中國當代醫(yī)藥;2016年12期

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