血浆不对称二甲基精氨酸对慢性肾脏病患者心脏结构及功能的预测价值

目的 探讨血浆不对称二甲基精氨酸(ADMA)水平对慢性肾脏病(CKD)患者心脏结构及功能的预测价值.方法 选取100例非透析CKD患者为研究对象.依照K-DOQI指南的分期标准,将患者分为5组.选取年龄匹配的健康体检者20例为健康对照组.用高效液相色谱法检测血浆ADMA水平和超声心动图检测心脏结构及功能.结果 CKD患者血浆ADMA水平(μmol/L)随着肾功能的减退而增高.CKD3、4、5期患者血浆ADMA水平(1.3318±0.4684、1.5712±0.4210、2.1093±0.7714)显著高于健康对照组(0.4611±0.1615)及CKD1、2期患者( 0.4387±0.2575、0.4809±0.2846)(均P＜0.01)；而CKD5期患者血浆ADMA又高于CKD3、4期患者.CKD4、5期患者左心室心肌质量指数(LMVI)( 140.24±40.52、150.21±46.23)显著高于健康对照组及CKD1 ～3期患者(均P＜0.01).ADMA与LMVI呈正相关(r=0.476,P=0.028),与心脏射血分数(EF)呈负相关(r=-0.327,P=0.041).多因素逐步回归分析结果显示血浆ADMA是EF降低的独立危险因素(OR=0.984,P＜0.01).结论 CKD患者血浆ADMA水平在CKD3期开始升高,并随着肾功能的减退而增加.血浆ADMA与左心室肥厚呈正相关,且是EF降低的独立危险因素,对心血管并发症有预测价值.

Value of plasma ADMA in predicting cardiac structure and function of patients with chronic kidney diseases

Objective To explore the predicting value of plasma asymmetric dimethylarginine (ADMA) in cardiac structure and function of patients with chronic kidney diseases (CKD). Methods A total of 100 CKD patients were enrolled in this cross-sectional study. According to staging of the K-DOQI guideline, CKD patients were divided into five groups. Twenty healthy people were enrolled as control. Plasma level of ADMA was determined by reversed-phase high performance liquid chromatography. Cardiac structure and function were detected by color echocardiography. Results Plasma levels (μmol/L) of ADMA in CKD stage 3 to 5 patients (1.3318±0.4684, 1.5712±0.4210, 2.1093±0.7714) were significantly higher than those in CKD stage 1, 2 patients (0.4387±0.2575, 0.4809±0.2846) and healthy control (0.4611±0.1615) (all P<0.01). Meanwhile, ADMA level of CKD stage 5 was significantly higher as compared to CKD stage 3-4. The left ventricular mass index (LVMI) was significantly higher in stage 4-5 patients than that in stage 1-3 and healthy control. Plasma ADMA was positively correlated with LVMI (r=0.476, P=0.028) and negatively correlated with left ventricular ejection fraction (EF) (r=-0.327, P=0.041). Multivariate stepwise Logistic regression analysis revealed plasma ADMA level was an independent predictors for EF (OR=0.984, P＜0.01). Conclusions Plasma level of ADMA begins to increase in CKD patients of stage 3 and rises proportionally to the decline of renal function. Plasma ADMA level is useful in predicting the cardiovascular complications of CKD patients.