维持血液透析患者血清瘦素、脂联素比值与颈动脉内中膜厚度进展的相关性研究

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者血清瘦素(Leptin)、脂联素(adiponectin,ADPN)比值(L/A)与颈动脉内中膜厚度进展(progression of carotid intima-media thickness,PROG-IMT)的相关性.方法 对首都医科大学附属复兴医院肾内科29例维持性血液透析患者进行随访观察,运用B超检查测定颈动脉内中膜厚度(IMT)2次,分别于实验开始时及 24月后,观察IMT变化(PROG-IMT);采用ELISA方法测定患者血清的瘦素、脂联素水平;同时检测血生化指标,评价透析充分性;结果进行统计学相关分析.结果①27例 MHD患者IMT有进展,MHD患者前后2次IMT差异有显著性(1.323±0.465比1.842±1.046,t=-3.313,P=0.003),并且前后2次结果对比相关系数 r=0.616,P=0.000,为高度正相关;② PROG-IMT与L/A显著正相关,Pearson相关系数r=0.405,P=0.029;③以PROG-IMT为因变量进行多元逐步回归分析显示:L/A是影响PROG- IMT的主要因素,B=30.207,t=2.299,P=0.029.结论 MHD患者IMT呈进行性进展,与原有病变程度密切相关,血清L/A是影响PROG-IMT的因素.

Correlation of serum leptin-to-adiponectin ratio with progression of carotid intima-media thickness in maintenance hemodialysis patients

Objective To investigate the correlation of serum leptin(LEP),adiponectin(ADPN) and leptin-to-adiponectin(L/A) ratio with the progression of carotid intima-media thickness(PROG-IMT) in maintenance hemodialysis(MHD) patients.Methods Twenty-nine MHD patients were involved in the study.Carotid ultrasound examinations were performed at the entry(1st test) and after 24 months(2nd test).Serum LEP and ADPN were determined by ELISA.Results ① PROG-IMT existed in 27 MHD patients,and the rest 2 MHD patients had no PROG-IMT.The intima-media thickness(IMT) in the 2nd test was significantly increased compared to that in the 1st test(P=0.003,paired t-test).Correlation analysis indicated that the 2nd test of IMT was positively correlated with the 1st test of IMT(r=0.616,P=0.000).② Correlation analysis also showed that L/A ratio was positively correlated with PROG-IMT(r= 0.405,P=0.029).③Multiple stepwise regression analysis showed that the higher L/A ratio was the risk factor for PROG-IMT.Conclusions IMT increased progressively in MHD patients.The PROG-IMT was significantly and positively correlated with the IMT at the entry.Higher L/A ratio was the risk factor for PROG-IMT.L/A ratio may become a sensitive predictor for insulin resistance in MHD patients.