血液透析患者血浆同型半胱氨酸与心血管疾病的关系

目的研究血液透析患者血浆同型半胱氨酸浓度、影响因素及与心血管疾病的关系。方法选择维持性血液透析患者65例和健康对照30例,记录患者心血管并发症,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。结果血液透析患者高同型半胱氨酸血症的发生率为89.2%。有心血管并发症组Ln（tHcy）明显高于无并发症组,两组Ln（tHcy）、三酰甘油、前白蛋白差异具有统计学意义（P〈0.05）,其余指标差异没有统计学意义（P〉0.05）。高tHcy血症与透析间期体重增加、血浆白蛋白及三酰甘油有关。糖尿病患者心血管并发症的发病率高于非糖尿病者（P〈0.05）,有心血管并发症组和没有并发症组之间tHcy差别没有统计学意义（P〉0.05）。多因素逐步回归分析显示高tHcy血症是血液透析患者心血管疾病的危险因素,而前白蛋白是保护因素。结论维持性血液透析患者存在高tHcy血症,高tHcy是其发生心血管疾病的危险因素。

Relationship between plasma homocysteine and cardiovascular disease in hemodialysis patients

Objective To study plasma total homocysteine（tHcy） level,the factors affecting tHcy level,and the relationship between tHcy level and cardiovascular disease（CVD） in hemodialysis patients.Methods We observed 65 maintenance hemodialysis（MHD） patients and 30 healthy volunteers in this study.Their CVD was recorded,and plasma tHcy was measured by fluorescence polarization immunoassay.Results Hyperhomocysteinemia was detected in 89.2% MHD patients.Plasma tHcy level was higher in patients with CVD than in those without CVD.Plasma tHcy,triglycerides and pre-albumin were significantly different between patients with CVD and those without CVD（P 〈 0.05）,but other biochemical parameters had no differences between the two patient groups（P 〉 0.05）.Hyperhomocysteinemia correlated with body weight gain in the dialysis period,plasma albumin and plasma triglycerides.The incidence of CVD was higher in patients with diabetes than those without diabetes（P 〈 0.05）.However,tHcy levels showed no difference between patients with CVD and those without CVD（P 〉 0.05）.Multiple stepwise regression analysis demonstrated that hyperhomocysteinemia was the risk factor for CVD,and pre-albumin was the protective factor for CVD in MHD patients.Conclusion Hyperhomocysteinemia is frequently seen in MHD patients,and is a risk factor for CVD in these patients.