维持性血液透析患者血清脂联素与动脉粥样硬化的相关性分析

目的探讨维持性血液透析患者血清脂联素水平与动脉粥样硬化的相关性。方法将30例维持性血液透析患者设为透析组,10名相匹配的健康体检者设为对照组,测定血清脂联素水平,同时测定相应的生化指标及颈总动脉内膜中层厚度,并根据颈动脉内膜厚度,将维持性血液透析患者分为颈动脉正常组和颈动脉硬化组。结果维持性血液透析患者血清脂联素水平明显高于对照组（P〈0．05）,与颈动脉内膜中层厚度呈显著负相关（r=－0．378,P〈0．05）;而颈动脉硬化组血清脂联素水平低于颈动脉正常组（P〈0．05）。结论维持性血液透析患者血清脂联素明显高于正常人,其浓度与动脉硬化程度呈负相关,对其更深一步的研究有助于对维持性血液透析患者动脉硬化的发生提供更好、更敏感的检测方法。     

维持性血液透析患者血清脂联素与营养状况的关系

目的探讨维持性血液透析患者血清脂联素与营养状况的关系。方法对81例维持性血液透析患者应用改良定量主观全面营养评估（MQSGA）法、血生化指标、人体指数学指标综合评估其营养状况,同时采用ELISA法测定血清脂联素水平,评估血清脂联素与营养状况之间的相关性。结果维持性血液透析患者营养不良患病率为69．1％。血清脂联素平均为（8．66±2．62）μg／ml,与MQSOA、肱三头肌皮褶厚度、上臂肌围、腰臀比、体重指数等营养指标成线性相关关系。结论维持性血液透析患者大多存在不同程度的营养不良,血清脂联素水平与营养指标相关,可作为评估血液透析患者营养不良的指标之一。     

维持性血透患者长期生存率与血清脂联素的关系

目的：探讨维持性血透患者长期生存率与血清脂联素的关系。方法：选择血液净化中心规律血液透析超过6个月的患者81例,随访16个月。分析其长期存活率,改良定量SGA评估法评估血透患者营养状况,测定体重指数、血红蛋白、胆固醇、三酰甘油、透析充分性,采用ELISA法测定血清脂联素水平,评估血清脂联素与血透患者长期生存率之间的关系。结果：维持性血透患者1年、2年、3年、5年、10年存活率分别为100%、90.12%、75.31%、38.27%、6.17%。Cox回归模型发现,年龄（r=1.088,P〈0.05）、ADPN（r=1.671,P〈0.01）是导致患者死亡的危险因素。透析开始年龄≤60岁组生存率高于〉60岁组（P〈0.05）。结论：血透开始年龄、血清脂联素水平是影响维持性血透患者生存率的危险因素。     

糖尿病肾病患者血清vaspin与血清脂联素的相关性

目的 探讨血清vaspin、血清脂联素水平与糖尿病肾病的相关性.方法 选择120例2型糖尿病患者,据尿白蛋白排泄率分为正常蛋白尿组(尿白蛋白排泄率＜ 20μg/min)40例、微量蛋白尿组(尿白蛋白排泄率20～200 μg/min)45例、大量蛋白尿组(尿白蛋白排泄率＞200μg/min)35例,另选健康体检者40名为对照组.分别采用酶联免疫吸附法测定空腹vaspin、脂联素水平,同时测定空腹血糖、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、空腹胰岛素、尿素氮、血肌酐,测量体质指数、腰围、收缩压和舒张压,比较各组间差异.结果 3组患者较对照组血清vaspin、脂联素水平显著升高,差异有统计学意义(P＜0.05).3组患者随着尿白蛋白排泄率升高,血清vaspin水平逐渐降低,差异无统计学意义(P＞0.05);随着尿白蛋白排泄率升高,血清脂联素水平逐渐升高,差异有统计学意义(P＜0.05).血清vaspin与体质指数、腰围、收缩压、空腹血糖、甘油三酯、空腹胰岛素呈正相关(P＜0.05);血清脂联素与空腹血糖、高密度脂蛋白胆固醇、空腹胰岛素、血肌酐呈正相关.结论 脂联素和vaspin均与糖尿病肾病有一定相关性,血清脂联素水平随着糖尿病肾病进展不断升高,而vaspin则随糖尿病肾病的进展下降.     

维持性血液透析患者甲状旁腺素水平与左心室肥厚关系的研究

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者甲状旁腺素(parathyroid hormone,PTH)水平与左心室肥厚(1eft ventrieular hypertrophy,LVH)的关系。方法选择同济大学附属同济医院血液透析中心MHD患者50例,根据患者PTH水平分成L-PTH组(PTH300 ng/L)、H-PTH组(PTH300 ng/L)。通过对2组患者进行心脏超声及临床生化检测,比较2组患者的心脏超声结构及LVH发生率,并作相关性分析。结果 2组患者的性别构成、年龄、血压、脑钠肽、血红蛋白、血钙和血白蛋白均无统计学差异(P0,05)。H-PTH组的透析时间、血磷均明显高于L-PTH组[(8,66±4,91)年比(5.4±5.73)年、(1.81±0.37)mmol/L比(1.51±0.32)mmol/L,P0.05]。H-PTH组的左室舒张末内径、左室收缩末内径、室间隔厚度与左室心肌质量指数均明显高于L-PTH组[(49.56±4.59)rmm比(45.84±5.65)mm、(32.44±4.26)mm比(29.6±5.00)mm、(11.12±1.45)mm比(10.16±1.41)mm、(144.29±31.82)g/m~3比(122.83±38.34)g/m~3,P0.05];2组的左房内径、左室后壁厚度及射血分数均无统计学差异[(43.96±3.98)mm比(42.52±5.86)mm、(9.56±1.58)mm比(9.08±1.29)mm、(63.16±6.97)%比(65.72±6.67)%,P0.05]。H-PTH组的LVH发生率明显高于L-PTH组(72%比40%,P0.05)。Spearman相关性分析表明,PTH水平与左室心肌质量指数、左室舒张末内径、左室收缩末内径、室间隔厚度呈正相关(r=0.325,0.330,0.348,0.310,P0.05),而与左房内径、左室后壁厚度、射血分数相关性无统计学意义(r=0.088,0.115,-0.210,P0.05)。结论MHD患者PTH水平增高可能是导致左心室肥厚的重要因素之一。     

氯沙坦对非糖尿病维持性血液透析患者血清脂联素及胰岛素抵抗的影响

目的 探讨氯沙坦对非糖尿病维持性血液透析患者血清脂联素水平和胰岛素抵抗的影响,及非糖尿病维持性血液透析患者血清脂联素与胰岛素抵抗的相关性.方法 测定62例非糖尿病维持性血液透析患者和30名健康对照者的血清胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、白蛋白、尿素氮、肌酐、C反应蛋白、收缩压、舒张压、血清脂联素、血糖、胰岛素,并计算稳态模型胰岛素抵抗指数及胰岛素敏感指数.分析血清脂联素与胰岛素抵抗等指标的相关性.将维持性血液透析患者按随机数字表法分为氯沙坦组(31例)和非氯沙坦组(31例),氯沙坦组给予口服氯沙坦每天50～100 mg,共6个月,测定治疗前、后两组血清脂联素、血糖、胰岛素及计算稳态模型胰岛素抵抗指数及胰岛素敏感指数.结果 维持性血液透析组患者甘油三酯、尿素氮、肌酐、C反应蛋白、血清脂联素、胰岛素、胰岛素抵抗指数、收缩压、舒张压水平与健康对照组比较差异有统计学意义(P分别＜ 0.01,＜0.05);而维持性血液透析组患者高密度脂蛋白及白蛋白水平与健康对照组比较差异也有统计学意义(P＜0.05).氯沙坦治疗组患者血清脂联素和胰岛素抵抗较治疗前比较差异也有统计学意义(P均＜ 0.01).相关分析显示血清脂联素、胰岛素、胰岛素抵抗指数、C反应蛋白、甘油三酯呈负相关(r分别为-0.282,- 0.362,- 0.411,-0.307,P分别＜0.05,＜0.01),血清脂联素与胰岛素敏感指数、胆固醇、高密度脂蛋白呈显著正相关(r分别为0.61、0.249、0.396,P分别＜0.05,＜0.01).结论 氯沙坦可使非糖尿病维持性血液透析患者血清脂联素升高,并减轻维持性血液透析患者高胰岛素血症和胰岛素抵抗.     

血清脂联素与大肠癌关系的研究

目的 通过比较大肠癌患者和健康人脂联素在血清中的浓度,研究其与大肠癌之间的关系,为大肠癌的早期诊断和治疗做初步研究.方法 对38例大肠癌患者和38例健康人采取新鲜血清应用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)测定脂联素的浓度,分析之间是否存在差异,及分析不同肿瘤组织病理分期、不同肿瘤大小等因素与脂联素浓度的关系.结果 大肠癌患者的血清脂联素水平159.89 ps/mL明显低于健康对照组184.5 pg/mL(P=0.001).P53的表达与患者血清脂联素水平无相关性(P=0.678).不同Dukes分期间的脂联素水平差异无统计学意义.但肿瘤超过5 cm的患者脂联素平均水平144.86 pg/mL,明显低于肿瘤小于5 cm患者脂联素平均水平178.47 pg/mL(P=0.04).结论 低水平的血清脂联素浓度与大肠癌发生有关,并且血清脂联素浓度与肿瘤大小有着负相关,可以推测脂联索在大肠癌的发生、发展过程中起重要作用.     

尿毒症血液透析患者血清脂联素与炎症标志物的关系

目的：探讨尿毒症血液透析患者血清脂联素（adiponectin）水平的变化；了解血液透析患者炎症标志物血清C反应蛋白（CRP）、血浆纤维蛋白原（Fbg）水平的变化以及脂联素与炎症标志物的关系。分析脂联素对炎症、血脂、动脉粥样硬化的影响。方法：应用ELISA法测定30例体检健康者与76例慢性肾衰竭尿毒症血液透析患者血清脂联素的水平；免疫比浊法测定血清CRP、凝固法测定血浆Fbg水平。结果：尿毒症组患者血脂联素CRP、Fbg水平明显高于健康对照组（P〈O．05或P〈0．01）。尿毒症患者血清脂联素与CRP、Fbg、体重指数（BMI）呈负相关，相关系数r分别为-0．50、-0．37、-0．34（P〈0．05或P〈0．01）。将尿毒症组依据cRP水平分为A、B两组，A组CRP〈5mg／L，B组CRP〉5mg／L。A组脂联素水平明显高于B组（P〈0．05）。结论：尿毒症血液透析患者体内存在微炎症状态。脂联素通过减轻炎症反应对尿毒症血液透析患者具有保护作用。     

丹参注射液对维持性血液透析患者胰岛素抵抗作用的临床研究

目的观察丹参注射液对维持性血液透析患者胰岛素抵抗的作用并探讨其机制。方法将60例存在胰岛素抵抗的血液透析患者随机分为两组,治疗组在血液透析中使用0．9％氯化钠100ml加丹参注射液20ml静滴,而对照组则使用氯化钠120ml静滴,疗程为6个月。检测治疗前、后胰岛素抵抗指数以及血脂、肝功能及脂联素水平,并将胰岛素抵抗指数与脂联素行相关分析,监测不良反应。结果两组治疗前指标及胰岛素抵抗指数无明显差异,治疗组在治疗后脂联素水平升高,血脂和胰岛素抵抗指数显著降低,而对照组无显著改变。两组患者治疗前、后肝功能无明显变化,未监测到明显不良反应,胰岛素抵抗指数与脂联素呈负相关。结论丹参注射液可提高脂联素表达水平,改善胰岛素抵抗。     

女性胆囊结石患者血清脂联素和雌激素的相关性研究

目的探讨女性胆囊结石患者血清脂联素和雌激素的相关性及其与胆石形成的关系。方法62例女性胆囊结石症患者,33例为绝经前,29例为绝经后。选择60例年龄匹配的正常体检人群作为对照。胆囊结石经B超确诊。测量身高、体重,计算体重指数。葡萄糖氧化酶法测定血糖。全自动生化分析仪比浊法测定血脂。放射免疫法测定血清脂联素和雌激素。结果与对照组比较,绝经前和绝经后的胆囊结石患者,血清脂联素显著降低(P0.01),雌激素显著升高(P0.01)呈负相关。血清脂联素与HDL-C和ApoA1呈正相关。结论低脂联素水平可能是雌激素导致胆石症的一个诱发因素,且独立于肥胖和糖尿病之外。     

维持性血液透析与腹膜透析患者左心室功能及相关因素分析

目的针对维持性肾脏替代治疗患者左心室功能情况及相关因素进行分析。方法将264例患者按不同肾脏替代治疗方式分为血液透析组（A组）和腹膜透析组（B组）,并常规检测血肌酐（SCr）、尿素氮（BUN）、血浆白蛋白（Alb）、血红蛋白（Hb）、血钙、血磷、血总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血全段甲状旁腺激素（iPTH）,超敏C反应蛋白（hs-CRP）;高压液相方法检测血浆同型半胱氨酸（Hey）;利用超声心动检查评价左心室功能。结果2组中,A组Hb、TG高于B组（P〈0．05）,而BUN低于B组（P〈0．05）;B组左心室舒张功能异常发生率高于A组（P〈0．01）;A组室间隔厚度、后壁厚度低于B组,而左室舒张末内径、左室收缩末内径及舒张早期和舒张晚期二尖瓣121最大血流速度之比（E／A）及射血分数（EF）高于B组,但只有舒张早期和舒张晚期二尖瓣口最大血流速度之比（E／A）有统计学差异（P〈0．01）;多因素Logistic回归分析显示,Alb、尿酸（UA）、hs—CRP、血钙、血磷水平是。肾脏替代治疗患者左室收缩功能障碍的危险因素;而年龄及收缩压与舒张压是其患者左室舒张功能障碍的危险因素。结论不同肾脏替代治疗方式下,患者左心室舒张功能异常发生率存在差异,纠正低蛋白血症,增加透析剂量,控制血压,减轻心脏负荷,纠正钙磷水平可能有助于改善其患者左心室功能异常。     

维持性血液透析患者心脏结构功能的危险因素分析

目的探讨影响维持性血液透析（MHD）患者心脏结构功能的危险因素。方法选择MHD患者153例,超声心动图测定心脏各项指标,并计算左心室心肌重量指数（LVMI）。生存函数乘积限（Kaplan-Meier）分析观察LVMI对患者预后的影响,分析影响LVMI的危险因素关系。结果153例MHD患者中,84例（占55．2％）患者存在左心室肥厚。多元回归结果显示超滤量（UF）和血红蛋白是影响左心室肥厚的独立危险因素。每周3次透析与每周2次透析的患者左心室肥厚的发生率分别为59．3％和52．1％。Kaplan-Meier生存分析显示左心室肥厚患者的5、10和15年生存率分为78．3％、54．3％和36．2％。结论MHD患者存在较高的左心室肥厚发生率,UF、血红蛋白与左心室肥厚相关,预防患者左心室肥厚可能有助于提高患者生存率。     

The relationship between indoxyl sulfate and left ventricular hypertrophy in hemodialysis patients

Objective To investigate the relationship between indoxyl sulfate (IS) and left ventricular hypertrophy (LVH) in hemodialysis patients. Methods For the eligible patients (age ≥18 years, dialysis duration > 6 months, without history of congestive heart failure within 3 months and comorbidity of cardiac aneurysm), clinical data were collected, biochemical measurements were completed, and echocardiographic examinations were performed. Plasma IS concentration was determined by high performance liquid chromatography electrospray tandem spectrometry (HPLC-ESI-MS/MS). Linear and Logistic regression models were employed to assess the associations of plasma IS and left ventricular mass index (LVMI) and LVH, respectively. Results Two hundred and ten hemodialysis patients (117 males) with mean age of（57.2 ± 14.3）years were enrolled. The prevalence of LVH was up to 64.0%. Univariate linear regression showed that plasma IS was positively correlated with LVMI (β=7.09, P=0.02). The result persisted after adjustment for all kinds of risk factors (β=4.16, P=0.03). Patients were categorized into two groups: LVH and non-LVH group. Logistic regression models were employed to assess the relationship of plasma IS and LVH. The result showed that plasma IS was independently associated with LVH after adjustment for other confounding risk factors (β=6.54, OR=1.13, 95%CI 1.09-1.44, P=0.03). Conclusions LVH is prevalent in hemodialysis patients. Plasma IS is significantly correlated with LVMI and the independent risk factor for LVH.     

Correlation analysis of N-terminal pro-brain natriuretic peptide in maintenance hemodialysis patients

Objective To analysis the distribution and influence factors of N-terminal pro-brain natriuretic peptide (NT-pro BNP), and also its clinical significance though a cross-sectional survey of NT-pro BNP in maintenance hemodialysis patients in Zhongshan Hospital, Fudan University. Methods A total of 207 stable hemodialysis patients were enrolled. The clinical parameters, plasma NT-proBNP levels and echocardiographic parameters were analyzed. Results Level of plasma NT-proBNP in patients with left ventricular hypertrophy (LVH) were significantly higher than those without LVH[M(1/4, 3/4): 3 104(1 626, 7 843) ng/L vs 1 291(772, 1 845) ng/L, P﹤0.01]. After logarithmic transformation for skewed variables NT-proBNP, log[NT-proBNP] was negatively correlated with hemoglobin (r=-0.212, P=0.004) and left ventricular ejection fraction (LVEF)(r=-0.202, P=0.003), and was positively correlated with left ventricular mass index (LVMI)(r=0.370, P=0.001), interdialysic weight gain (IDWG) rate (r=0.233, P=0.001), predialysis systolic blood pressure (r=0.345, P=0.001), predialysis diastolic blood pressure (r=0.152, P=0.032). The areas under curve(AUC) of NT-proBNP for diagnosing LVH and IDWG﹥4% were 0.786(95%CI 0.689-0.883, P﹤0.01) and 0.738(95%CI 0.667-0.810, P﹤0.01). When the threshold of NT-proBNP was set at 1 917 ng/L to diagnosis LVH, the sensitivity and specificity were 0.676 and 0.824. When the threshold of NT-proBNP was set at 2 872 ng/L to diagnosis IDWG﹥4%, the sensitivity and specificity were 0.704 and 0.758. Conclusions NT-proBNP levels are significantly abnormality in hemodialysis patients, mainly related with LVH, the high rate of IDWG, and the poorly controlled predialysis blood pressure. Proper dry weight assessment and strict control of IDWG may be effective way to intervene NT-proBNP.     

Correlation between hypervolemia,left ventricular hypertrophy and fibroblast growth factor 23 in hemodialysis patients

Abstract

Introduction: Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular complications in hemodialysis (HD) patients. Hypervolemia has been accepted as an independent risk factor for progressive LVH in HD patients. Additionally, high FGF23 levels have been a significant predictor of cardiovascular mortality and morbidity in chronic kidney disease and HD patients. The aim of our study is to investigate the correlation among LVH, interdialytic volume increase and FGF-23 in the patients on a chronic hemodialysis program. Design and methods: A total of 97 chronic hemodialysis patients (64.43?±?11.28 years old, M/F:47/50) were included in the study. Human FGF-23 ELISA kit was used for FGF-23 analysis of predialysis blood samples. Echocardiographic evaluation was performed in all of the patients after dialysis. Left Ventricular Mass Index (LVMI) was calculated by using the Devereux Formula. We collected the following data: LVMI, FGF-23 levels, interdialytic fluid gain, blood pressure changes, and the other biochemical and clinical parameters. Results: Mean LVMI of the patients was 184.41?±?48.62?g/m². LVMI of the patients with daily urine output >250?mL was found significantly lower. Statistically significant positive correlation was found between predialysis systolic blood pressure, predialysis diastolic blood pressure, predialysis mean arterial blood pressure and LVMI measurements (p?<?0.01). Mean interdialytic volume excess was correlated with LVMI measurements of the patients (r?=?0.459; p?<?0.01). Increased FGF-23 levels (159.79?±?134.99?ng/L) predicted increased LVMI measurements of the patients (r?=?0.322; p?<?0.01). In addition, FGF-23 levels were also increased as the interdialytic fluid volume increased (r?=?0.326; p?<?0.05). A positive correlation was also found between FGF-23 levels and interventricular septum thickness (r?=?0.238; p?<?0.05). Predialysis mean arterial blood pressure, predialysis volume overload and presence of diabetes were determined to be independent risk factors on LVMI on multivariate regression analysis. Conclusion: Our study showed that interdialytic volume overload increased both LVMI and FGF-23 values. We can consider that interdialytic volume control exerts positive effects on increased FGF-23 levels which predict the negative cardiovascular outcomes.     

慢性肾脏病患者血浆同型半胱氨酸水平与左心室肥大的关系

目的探讨早期慢性肾脏病（CKD）血浆同型半胱氨酸（Hcy）水平及其与左心室肥大（LVH）的关系。方法64例早期CKD患者分为3组,即A组[eGFR≥90ml·min^-1·（1．73m^2）^-1]31例;B组[eGFR60～89ml·min^-1·（1．73m^2）^-1]22例;C组[eGFR30～60ml·min^-1（1．73m^2）^-1]11例。另设同期健康体检者25例为对照组（N组）。采用荧光偏振免疫分析法测定血浆Hcy浓度,心脏超声检测左室舒张末期内径（LVDd）、室间隔厚度（IVST）和左室后壁厚度（LVPWT）、左心室心肌质量指数（LVMI）。结果①A组血浆Hcy与N组比较无统计学差异（P〉0．05）;B组和C组血浆Hcy显著高于A组和N组（P〈0．01）;C组血浆Hcy显著高于B组（P〈0．01）。CKD组高Hcy（〉12μmol／L）比例为39．06％,是N组的3．26倍。②A组、B组和C组各期左室质量指数（LV—MI）、左室舒张末期内径（LVDd）、室间隔厚度（IVST）、左室后壁厚度（LVPWT）均较N组显著增加。③血浆Hcy与LVPWT显著正相关（r=0．400,P=0．000）,与LVMI、LVDd、IVST无相关性。结论早期CKD即出现高Hcy血症,随肾功能进展而加重;血浆Hcy与早期CKD的左心室肥厚有关。     

Incidence and risk factors of left ventricular hypertrophy in peritoneal dialysis patients with different hydration statuses

Objective To investigate the incidence of left ventricular hypertrophy (LVH) in peritoneal dialysis (PD) patients with different hydration statuses, and analyze the risk factors of LVH in PD patients. Methods PD patients in Renji Hospital, Shanghai Jiao Tong University School of Medicine from September 2016 to January 2017 were enrolled. Demographic data of patients were collected and biochemical parameters were measured. Hydration status index overhydration (OH) was measured by bioimpedance spectroscopy, and LVH was diagnosed by echocardiography. Logistic regression was used to analyze the risk factors of LVH. Results A total of 113 PD patients aged 58.98(48.89, 65.33) years with median PD duration 46.20(18.08, 72.75) months were enrolled in present study, among whom 60 patients (53.1%) had LVH. OH＞1.1 L was detected in 80 patients (70.8%), among whom 34 patients (42.5%) had subclinical overhydration (SCOH). LVH was however diagnosed in 33(71.7%) clinical overhydrated (COH) patients and 17(50.0%) SCOH patients (n=34). In the normal hydrated (OH≤1.1 L) patients (n=33), LVH was detected in 10 patients (30.3%). Multivariate logistic regression showed that high OH (OR=1.730, 95%CI 1.274-2.348, P＜0.001) and low hemoglobin (OR=0.965, 95%CI 0.940-0.991, P=0.008) were the independent risk factors of LVH. Conclusions LVH is common in PD patients, especially in overhydrated patients. High OH and low hemoglobin were the independent risk factors of LVH.     

维持性血液透析患者冠心病介入治疗

目的探讨维持性血液透析患者合并冠心病心脏介入治疗的安全性和可行性。方法回顾性分析本院7例血液透析合并冠心病患者在强化透析的基础上应用非离子型低渗造影剂行冠状动脉造影术＋支架植入术的临床资料。结果单支病变3例,多支病变4例,行经皮腔内冠状动脉成形术（PTCA）置放支架1～2个。死亡3例,病情改善4例。此4例术后心绞痛症状改善,肾功能无进一步恶化。结论血液透析患者中合并不稳定心绞痛患者可考虑冠状动脉介入治疗,疗效较好,但对于同时有心肌酶谱升高者预后不良。