血硒对维持性血液透析患者左心室结构与功能的影响

目的探讨血硒对维持性血液透析(maintenance hemodialysis,MHD)患者左心室结构和功能的影响及其可能机制。方法运用质谱法、放射免疫法、化学发光法和生化比色法分别对40例MHD患者、40例非透析慢性肾衰竭(non-hemodialysis,NOHD)患者和30例正常对照者的血硒、甲状腺激素(thyroid hormone,TH)、甲状旁腺激素(parathyroid hormone,PTH)、氧化应激指标进行测定;应用Philips CX50彩色B超测定左心室内径(left ventricular diameter,LVD)、左心房内径(left atrial diameter,LAD)、左心室舒张末内径(left ventricular end-diastolic diameter,LVDd)、左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)、室间隔厚度(interventricular septum thickness,IVST)、左心室射血分数(left ventricular ejection fraction,LVEF),按Devereux公式计算左心室质量指数(left ventricular mass index,LVMI)。分析血硒与其他参数的关系及其对左心室结构和功能的影响。结果MHD患者血硒、总三碘甲状腺原氨酸(total triiodothyronine,TT 3)、游离T 3(free triiodothyronine,FT 3)含量均低于正常对照组(P<0.01),PTH含量高于正常对照组(P<0.01),超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)活性低于正常对照组(P<0.01),丙二醛(malondialdehyde,MDA)含量高于正常对照组(P<0.01),C反应蛋白(C-reactive protein,CRP)含量高于正常对照组(P<0.01),LAD、LVDd和LVMI均高于正常对照组(P<0.01)。MHD患者血硒与GSH-Px、SOD、TT 3、FT 3呈正相关(P<0.05),与CRP、MDA、LAD、LVDd呈负相关(P<0.05);GSH-Px与LAD、LVDd、IVST、LVMI呈负相关(P<0.05),SOD与LAD、IVST、LVMI呈负相关(P<0.05),MDA与LAD、LVDd、IVST、LVMI呈正相关(P<0.05);TT 3、FT 3与LAD、LVDd、IVST、LVMI呈负相关(P<0.05);PTH与LAD、LVDd、IVST、LVMI呈正相关(均P<0.01);CRP与LAD、LVDd、IVST、LVMI呈正相关(P<0.05)。结论低硒可能通过引起机体抗氧化能力降低、TH和PTH代谢紊乱、炎症反应增强,而加重MHD患者左心室结构和功能异常。

Effect of blood selenium on left ventricular structure and function in maintenance hemodialysis patients

Objective To explore the effect of blood selenium on left ventricular structure and function in maintenance hemodialysis(MHD)patients and its possible mechanism.Methods Blood selenium,thyroid hormone(TH),parathyroid hormone(PTH)and oxidative stress indicators were measured by mass spectrometry,radioimmunoassay,chemiluminescence and biochemical colorimetry in 40 MHD patients,40 non-dialysis patients with chronic renal failure(NOHD)and 30 normal controls respectively.Philips CX50 color ultrasound was used to measure left ventricular diameter(LVD),left atrial diameter(LAD),left ventricular end diastolic diameter(LVDd),left ventricular posterior wall thickness(LVPWT),interventricular septal thickness(IVST)and left ventricular ejection fraction(LVEF).Left ventricular mass index(LVMI)was calculated according to Devereux formula.The relationship between blood selenium and other parameters and its influence on the structure and function of the left ventricle were analyzed.Results The serum selenium,TT 3 and FT 3 in patients with MHD were lower than that of the normal control group(P<0.01).The content of serum PTH in patients with MHD was higher than that of the normal control group(P<0.01).The serum superoxide dismutase(SOD)and glutathione peroxidase(GSH-px)activities in patients with MHD were lower than those in normal control group(P<0.01),while malondialdehyde(MDA)was higher than that in normal control group(P<0.01).CRP content was higher than that in the normal control group(P<0.01).LAD,LVDd and LVMI in MHD patients were higher than those in normal control group(P<0.01).Bivariate correlation analysis showed that,in MHD patients,there was a positive correlation between serum selenium and GSH-Px,SOD,TT 3 and FT 3(P<0.05);and negative correlation with CRP,MDA,LAD and LVDd(P<0.05).GSH-Px was negatively correlated with LAD,LVDd,IVST and LVMI(P<0.05);SOD was negatively correlated with LAD,IVST and LVMI(P<0.05);and MDA was positively correlated with LAD,LVDd,IVST and LVMI(P<0.05).TT 3 and FT 3 were negatively correlated with LAD,LVDd,IVST and LVMI(P<0.05).PTH was positively related to LAD,LVDd,IVST and LVMI(all P<0.01).CRP was positively correlated with LAD,LVDd,IVST and LVMI(P<0.05).Conclusions Selenium deficiency may aggravate left ventricular structural and functional abnormalities in MHD patients by reducing antioxidant capacity,disturbing TH and PTH metabolism and increasing inflammation.