慢性肾脏病患者Hcy水平与IMT及左室结构关系的临床研究

目的观察不同同型半胱氨酸（Hcy）水平的慢性肾脏病患者颈动脉内膜中层厚度（IMT）及反映心脏结构的各项指标间的差异,了解慢性肾脏病患者Hcy与反映大动脉粥样硬化指标IMT及反映心脏结构的各项参数间关系。方法测定66例慢性肾脏病患者和32例对照组血Hcy、SCr水平,同时进行颈动脉和心脏彩色多普勒超声检查,并进行收缩压、舒张压测定。结果与对照组相比,肾病组（无论Hcy正常与否）,IMT、LVEDd、LVMI均增加,Hcy增高肾病组较对照组LVPWT、IVST亦增高（P值分别为0.042、0.017）,具统计学差异。与Hcy正常肾病组相比,Hcy增高肾病组IMT及反映左室结构的各项指标（LVEDd、LVPWT、LVMI、IVST）均明显增高,有统计学差异。线性相关分析显示血浆Hcy与IMT、LVEDd、LVMI相关。结论高Hcy血症慢性肾病患者,存在动脉粥样硬化程度及左室结构异常加剧情况,预示着心血管事件的发生率增高。

Clinical Study of the Relationship between Homocysteine, Intima-medial Thickness of Extracranial Common Carotid Artery and the Structure of Left Ventricle in Patients with Chronic Renal Diseases

Objective To investigate the relationship between homocysteine （Hcy）, intima-medial thickness of extracranial common carotid artery （IMT） and the structure of left ventricle in patients with chronic renal diseases. Methods Hcy, IMT, systolic blood pressure, diastolic blood pressure and the parameter of ultrasonic cardiogram were determined in 66 patients of chronic renal diseases and in 32 normal cases, and the differences between them were compared. Results IMT, LVEDd and LVMI were significantly increased in patients with chronic renal disease （regardless of the level of Hcy） than that in normal cases （P 0.05）. LVPWT and IVST were also significantly higher in patients with high Hcy than that in normal cases （P = 0.042, 0.017）. IMT, LVEDd, LVPWT, LVMI and IVST were higher in high Hcy group than that in normal Hcy group. Linear regression analysis showed a significant positive correlation between Hcy and IMT, LVEDd. Conclusions Hyperhomocysteinmia in patients with chronic renal diseases can evaluate the degree of atherosclerosis and the structure of left ventricle.