血浆不对称二甲基精氨酸与慢性肾脏疾病非透析患者心血管并发症的关系

目的 探讨不对称二甲基精氨酸（ADMA）与慢性肾脏疾病（CKD）非透析患者心血管并发症（CVD）的关系。 方法 高效液相色谱-质谱联用仪检测76例患者的血浆ADMA水平，分析其与颈动脉超声、心脏超声等相关指标及既往CVD病史的关系。 结果 CKD非透析患者的血浆ADMA水平较健康对照组显著升高(41.56±12.76) 比 (17.12±7.09) mg/L, P < 0.01]。逐步多元回归分析显示ADMA是颈总动脉内-中膜厚度（β = 0.544, P < 0.01）和左室心肌重量指数（β = 2.521, P < 0.01）的独立危险因素。既往有CVD史者其血浆ADMA水平较既往无CVD史者显著升高(47.60±15.14)比 (36.93±8.10) mg/L，P < 0.01]。Logistic回归分析显示血浆ADMA（β = 1.117，95%CI：1.013~1.232, P < 0.05）是CKD非透析患者CVD的独立危险因素。 结论 CKD患者普遍存在CVD，ADMA可能参与了CKD非透析患者CVD的发生发展。

Relationship between plasma asymmetric dimethylarginine and cardiovascular disease in non-dialytic patients with chronic kidney disease

Objective To investigate the relationship between plasma asymmetric dimethylarginine (ADMA) and cardiovascular disease (CVD) in patients with non-dialytic chronic kidney disease (CKD). Methods Seventy-six patients with CKD (mean age 46 years, 39 female, 37 male) and 15 healthy controls were enrolled. Plasma ADMA was measured by HPLC-MS. The relationship between plasma ADMA level and CVD in non-dialytic CKD patients was investigated with Logistic regression model. Results Mean plasma ADMA level increased significantly in CKD group compared to control group (41.56±12.76) vs (17.12±7.09) mg/L, P < 0.01], even in those patients in early stage of CKD. The plasma levels of ADMA were higher in renal patients with congestive heart failure or artherosclerosis cardiovascular diseases than that in those without (both P < 0.05). Plasma ADMA level was positively correlated with left ventricular mass index (r = 2.521, P < 0.01) and intima-media thickness of common carotid artery (r = 0.544, P = 0.002). Multiple regression analysis showed that plasma ADMA level was the independant risk factor of LVMI and intima-media thickness of common carotid artery in CKD patients. Logistic regression analysis further indicated that ADMA （β = 1.117，95%CI: 1.013~1.232, P = 0.027）was an independent risk factor of CVD in non-dialytic CKD patients. Conclusion Increased plasma ADMA concentration is found at even very early stage of CKD and may play a role in pathogenesis and progression of CVD in these patients.