维持性血液透析患者高同型半胱氨酸和营养不良和.doc

PAGE \* MERGEFORMAT 9 维持性血液透析患者高同型半胱氨酸与营养不良及 心血管结构与功能的关系研究 罗凯1，汪贤聪2，张继成2,凃玲1 [1] 华中科技大学附属同济医院综合科，湖北武汉430030 [2]?武警湖北总队医院，湖北武汉430061 摘要 目的：探讨维持性血液透析（Maintenance Hemodialysis，MHD）患者血浆中同型半胱氨酸（Homocysteine，Hcy）水平；MHD患者中Hcy水平与营养不良及心血管结构和功能之间的相关性。 方法：选取在武汉武警医院进行维持性血液透析的40例终末期肾脏疾病（ESRD）患者作为研究对象，一方面观察患者血常规、肾功能、血脂、心肌酶谱以及Hcy等指标。研究血浆中Hcy的水平及其与患者各项生化指标之间的关系。另一方面应用多普勒超声仪检测MHD患者的心血管结构与功能指标，采用相关性分析MHD患者血浆Hcy水平与患者心血管结构和功能之间的关系。 结果：（1）在40例MHD患者中92.5%的患者血浆Hcy水平超出正常范围。（2）相关性分析发现，Hcy水平与患者白蛋白、血红蛋白具有显著相关性（相关系数r分别为-0.385和-0.441，P值分别为0.029和0.011）。（3）40例MHD患者中心血管结构与功能异常的发生率为77.5%。分析显示，MHD患者血浆中Hcy与室间隔舒张末厚度正相关（r=0.259，P=0.011），与呈负相关关系（r分别为-0.311和-0.368，P值分别为0.005和0.032）。 结论：MHD患者发生高同型半胱氨酸血症具有普遍性；MHD患者的高Hcy水平与患者白蛋白、血红蛋白、室间隔舒张末厚度、E/A比值以及射血分数密切相关。因此，血浆Hcy水平可作为MHD患者发生营养不良和心血管系统疾病的危险标志物。 关键词：维持性血液透析；同型半胱氨酸；营养不良；心血管疾病 The relationship study of homocysteine correlation with malnutrition and cardiovascular structure and function in maintenance hemodialysis patients ABSTRACT Objective: To evaluate plasma homocysteine (Hcy) level in maintenance hemodialysis patients; to investigate the correlation between plasma Hcy level and malnutrition and cardiovascular structure and function in maintenance hemodialysis patients; Methods: 40 cases of end-stage renal disease patients who received maintenance hemodialysis treatment in Armed Police Hospital of Wuhan were chosed as research object. On the one hand, blood routine examination, renal function indices, blood lipid test, myocardial enzyme spectrum, Hcy and other biochemical parameters were measured to study the correlation coefficient between Hcy level and the biochemical parameters of patients in this study. On the other hand cardiovascular structure and function were measured by echocardiography.Then the correlation between Hcy level and cardiovascular structure and function was researched by correlation analysis. Results: (1) Plasma Hcy level in 92.5% of 40 MHD patients exceeded the normal range. (2) Correlation analysis showed a significant correla