尿毒症血液透析患者高同型半胱氨酸血症与动脉粥样硬化关系的研究

目的探讨尿毒症血液透析患者血浆同型半胱氨酸浓度与动脉粥样硬化的关系。方法对北京朝阳医院血液透析中心2003-10~2004-01采用荧光偏振免疫分析法测定血浆总同型半胱氨酸(tHcy)浓度,应用彩色多普勒超声诊断仪检测颈动脉内膜-中层厚度(IMT),并根据公式计算颈动脉Young弹性指数、斑块阳性率,用免疫化学发光法测定血清叶酸、VitB12浓度。结果尿毒症血液透析患者高同型半胱氨酸血症发生率为68.3%,尿毒症血液透析患者血清叶酸和VitB12浓度与血浆tHcy呈负相关。IMT、颈动脉Young弹性指数、斑块阳性率与血浆tHcy浓度呈正相关(r分别为0.34,0.31,0.23,P均<0.05),这种相关性在应用多元Logistic回归剔除了性别、年龄、血压、血脂、血糖、血红蛋白等因素影响后仍然存在。结论高同型半胱氨酸血症可能是尿毒症血液透析患者发生动脉粥样硬化的独立危险因素。

The relationship between hyperhomocyseinemia and atherosclerosis in hemodialysis patients

Objective To determine the relationship between hyperhomocyseinemia and atherosclerosis in hemodialysis patients.Methods Plasma total homocysteine (tHcy)concentrations were measured by using fluorescence polarization immunoassay.Carotid initial-medial thickness(IMT)was measured by echocardiography.Cardiovascular parameters including carotid Young elastic index and the prevalence of atherosclerosis plaques were calculated by established formulas.Results The prevalence of hyperhomocyseinemia was 68.3% in the hemodialysis patients.The folate and vitamin B_(12) concentrations were higher in patients than those in controls.Cartid IMT,carotid Young elastic index and the prevalence of atherosclerosis plaques were positively and independently correlated with tHcy (r=0.34,0.31,0.23).Multivariate stepwise regression indicated that the correlation also existed independently of other conventional risk factors such as age,sex,blood pressure,Scr,glucose.Conclusion The results indicate that hyperhomocyseinemia may be an independent risk factor for atherosclerosis found in hemodialysis patients.