血液透析相关性肌痉挛与血管内皮功能紊乱相关

目的血液透析相关性肌痉挛的发生机制至今尚未明确，本研究探讨内皮功能紊乱与血液透析相关性肌痉挛的相关性。方法共收集15例血液透析中频发肌痉挛（A组）和12例无肌痉挛发作史（B组）的维持性血液透析患者。于2个月的观测期内记录各组患者血液透析相关性肌痉挛的发作次数，并于观测期内透析间日检测肱动脉血流介导的血管舒张功能（F10w—mediated dilatations，FMD）和血浆血管性假性血友病因子（vWF）。结果在2组基本状况基本一致的情况下，于观察期内，A组的血液透析相关性肌痉挛发作次数明显高于B组（6．8±0．5比1．2±0．1次／4周，t=38．05，P〈0．01）。检测和统计分析发现，A组患者的FMD显著低于B组患者（6．9±2．5比12．4±2．3，t一5．88，P〈0．01），而vWF的水平明显高于B组（235．7±56．2比133．7±18．3，t=6．02，尸〈0．0i）。统计分析还表明，FMD与患者的肌痉挛次数显著负相关（r=-0．61，P〈0．05），而vWF与患者的肌痉挛次数显著正相关（r=O．55，P〈0．05）。结论血液透析相关性肌痉挛可能与患者的内皮功能紊乱相关，改善患者内皮功能可能有利于避免血液透析相关性肌痉挛。

Hemodialysis-related muscle cramp is associated with endothelial dysfunction

Subjective The mechanism of muscle cramp in hemodialysis patients is not well understood. This study aimed to determine the relationship between endothelial dysfunction and hemodialysis-related muscle cramps. Methods Fifteen hemodialysis patients with frequent muscle cramps （group A）, and twelve hemodialysis patients without muscle cramps （group B） were enrolled. The episodes of hemodialysis-related muscle cramps were recorded over a 2-month period. Flow-mediated dilatation was measured in brachial artery, and plasma vWF was measured at the mid-interdialysis day in second month of the period. Results The incidence of symptomatic muscle cramps was significantly higher in group A than in group B （6.8：i：0.5 vs. 1.2±0.1 times/4 weeks, t=-38.05, P〈0.01）. Flow-mediated dilatation was significantly lower in group A comparing with that in group B （6.94-2.5 vs. 12.4±2.3, t=--5.88, P 〈 0.01）. In addition, plasma vWF was significantly higher in group Athan in group B （235.7-4-56.2 vs. 133.7±18.3, t=6.02, P〈0.01）. The frequency of hemodialysis-related cramps was adversely correlated with the value of flow-mediated dilation （r=-0.61, P〈 0.05）, and positively correlated with the plasma level ofvWF （r=0.55, P ~ 0.05）. Conclusion Endothelial dysfunction is associated with frequent hemodialysis-related cramps. Improving endothelial dysfuction