终末期肾脏病维持性血液透析患者微炎症与贫血和营养不良及左心室功能的关系

目的 探讨终末期肾脏病维持性血液透析患者超敏C反应蛋白与贫血、营养不良及左心室功能间的关系.方法 将患者分为微炎症组(超敏C反应蛋白＞3 mg/L)和非微炎症组(超敏C反应蛋白≤3 mg/L),检测100例维持性血液透析患者超敏C反应蛋白、血清白蛋白、三酰甘油、总胆固醇、脂蛋白(a)、血肌酐、血红蛋白及红细胞压积;用彩色超声多普勒显像仪测定左心房前后径、左心室前后径、左心窜舒张期后壁厚度、室间隔厚度、左室射血分数,舒张早期左室充盈峰速率与心房收缩期左室充盈峰速率比值、计算左心室质量指数,测不同时间(5次)血压并取均值,分析超敏C反应蛋白与上述各参数间的关系.结果 (1)微炎症组患者血红蛋白、红细胞压积、血清白蛋白脂蛋白(a)与非微炎症组比较差异有统计学意义(P分别＜0.01,＜0.05);(2)微炎症组患者左心房前后径、左心室前后径、左心室舒张期后壁厚度、室间隔厚度、左心室质量指数、左室射血分数、舒张早期左室克盈峰速率与心房收缩期左室充盈峰速率比值与非微炎症组比较差异也有统计学意义(P分别＜0.05,＜0.01);(3)相关分析结果表明,血清超敏C反应蛋白浓度与血红蛋白、红细胞压积、血清白蛋白呈负相关(r分别=-0.283、-0.308、-0.387,P分别＜0.05、＜0.01),与脂蛋白(a)呈正相关(r=0.427,P＜0.01);与左心室前后径、室间隔厚度、左心室质量指数呈显著正相关(r分别=0.277、0.394、0.307,P均＜0.05);与左室射血分数、舒张早期左室充盈峰速率与心房收缩期左室充盈峰速率比值呈显著负相关(r分别=-0.386、-0.543,P均＜0.01);(4)血清超敏C反应蛋白、血红蛋白、红细胞压积、Kt/V值、血清白蛋白、脂蛋白(a)、收缩压、脉压是维持性血液透析患者心脏结构及功能异常危险因素.结论 维持性血液透析患者存在微炎症状态时血清超敏C反应蛋门升高.血清超敏C反应蛋白可预测维持性血液透析患者的贫血程度、营养状态,并可用来评价左心室结构和功能,且是左心室结构和功能异常的独立危险因素.

Relationship between microinflammatory state of end-stage renal disease and anemia,malnutrition,left ventricular function in maintenance hemodialysis patients

Objective To study microinflammatory state of end-stage renaldisease patients in mainrained hemodialysis(MHD) and the relationship between microinfl-ammatory state of end-stage renal disease and anemia,malnutrition,left ventricular function in maintained hemodialysis patients.Methods One hundred patients undergoing hemodialysis were divided into non-mi-croinflammation group (hs-CRP≤3 mg/L)and microinflammation group( ha-CRP ＞ 3 mg/L).The serum levels of hs-CRP,albumin,triglyceride(TG),total cholesterol(TC),lipoprotein(a)LP(a)]and serum creatinine(Scr) were determined.The levels of hemoglobin (Hb) and hematocrit (Hct) were detected.The left atrial (LAD) and ventricular diameter (LVD),interventricular septum thickness(IVST),left ventricular posterior wall thickness (LVPW),left ventricular ejective fraction(FT),ratio of E/A were measured by color doppler echocardiography,and left ventricular mass index(LVMI) was caculated.Blood pressure was measured in different 5 stages,and their relation were analysed.Results ( 1 )The levels of Hb,Hct,Alb in microinflammation group were lower than those in contol group( P ＜ 0.05,＜0.01),the level of LP(a) was higher than that in the non-microinflammation group (P ＜0.05);(2)The levels of LAD,LVD,LVPW,IVST,LVMI in elevated microinflammation group were higher than those in control group( P ＜ 0.05,＜ 0.01 ),the levels of EF and E/A were lower than those in non-microinflammation group ( P ＜ 0.05,＜ 0.01 );(3) Blood serum hs-CRP concentration was correlated negatively with the level of Hb,Hct ( P ＜ 0.05),Alb( P ＜ 0.05 ) and inversely with LP(a) ( P ＜ 0.05).Blood serum hs-CRP concentration was correlated positively with LVD,IVST,LVMI (P ＜ 0.05) and inversely with EF,E/A (P＜0.05);(4)hs-CRP,Hb,Hct,Kt/V,Alb,Lp(a),SBP,PP were risk factors of abnormal left ventricular structure and function.Conclusion In patients undergoing maintenance hemodialysis,persistent increase of hs-CRP indicates the presence of microinflammation,hs-CRP might be a marker for the anemia,nutrition status and left ventricular structure and function.Elevated hs-CRP is an independent risk factor of abnormal left ventricolar structure and function.