维持性血液透析患者贫血与动脉硬化的关系

目的探讨维持性血液透析（maintenance hemodialysis,MHD）患者贫血与动脉硬化的关系。方法选取82名病情稳定的非糖尿病肾病MHD患者为研究对象,根据血红蛋白（Hb）浓度分组,A组,Hb浓度〈100g/L,45例;B组,Hb浓度≥100g/L,37例。应用高分辨二维超声测量透析患者颈动脉内膜-中层厚度（IMT）。记录各患者的临床观察指标,透前采血测定患者循环丙二醛（MDA）、超氧化物歧化酶（SOD）及其他生化指标,评估两组患者的Kt/V值,进行相关及多元回归分析以判断相应指标之间的关系,筛选颈动脉IMT的影响因素。结果A组患者颈动脉IMT、收缩压、脉压及MDA水平高于B组（P〈0.01）,A组SOD及白蛋白水平低于B组（P〈0.01）。Pearson相关分析显示MDA（r=-0.567,P=0.000）及SOD水平（r=0.482,P=0.000）与Hb浓度显著相关;颈动脉IMT与年龄（r=0.658,P=0.000）、收缩压（r=0.441,P=0.000）、Hb浓度（r=-0.398,P=0.000）、白蛋白（r=-0.483,P=0.000）及MDA（r=0.278,P=0.011）水平显著相关。多元线性逐步回归分析显示,Hb浓度、年龄、收缩压、白蛋白水平是影响颈动脉IMT的危险因素（R2=0.646,P〈0.001）。结论贫血与颈动脉IMT增厚密切相关,贫血是MHD患者颈动脉IMT增厚的独立危险因素。贫血可能通过氧化应激加重动脉硬化的发生。

The relationship between anemia and arterial stiffness in maintenance hemodialysis patients

Objective To study the relationship between anemia and arterial stiffness in maintenance hemo-dialysis（MHD） patients.Methods Eighty-two clinically stable MHD patients but excluding diabetic nephropathy were enrolled in this study.They were divided into two groups based on hemoglobin（Hb） level： group A,Hb 〈100g/ L（N=45）;group B,Hb ≥ 100g/L（N=37）.Intima-medium thickness（IMT） of carotid artery was evaluated by high-resolution B-mode ultrasonograph.Their clinical manifestations and Kt/V were recorded.Plasma malondialdehyde（MDA）,superoxide dismutase（SOD） and other biochemical parameters were measured.Pearson’s correlation and backward multiple regression analysis were used to identify the relationship between hemoglobin and IMT.Results Patients in group A had higher IMT,systolic blood pressure（SBP）,pulse pressure and serum MDA（P 〈 0.01）,but lower serum SOD and albumin（P 〈 0.01）,as compared with those of the patients in group B.Pearson’s correlation revealed that Hb was significantly correlated with MDA（r=-0.567,P=0.000） and SOD（r=0.482,P=0.000）.In addition,IMT was significantly correlated with age（r=0.658,P=0.000）,SBP（r=0.441,P=0.000）,hemoglobin（r =-0.398,P = 0.000）,albumin（r=-0.483,P=0.000） and MDA（r=0.278,P=0.011）.Backward multiple regression analysis demon-strated that IMT was independently determined by Hb,age,SBP and albumin level（R2=0.646,P 〈 0.001）.Conclu-sions In MHD patients,anemia was closely correlated with IMT of carotid artery,and was an independent risk factor for increased IMT of carotid artery.Anemia aggravates arterial stiffness possibly through oxidative stress.