血液透析患者血清Hcy水平与动脉粥样硬化及心脏结构功能的关系

目的 探讨维持性血液透析(MHD)患者血清同型半胱氨酸(Hcy)水平与动脉粥样硬化及心脏结构功能的关系.方法 选择2015年1月至2016年10月间我院治疗的74例MHD患者为研究对象,检测患者血清Hcy水平,并用超声测定颈动脉内膜中层厚度(IMT)及左室射血分数(LVEF)、左心室心肌质量指数(LVMI)、左心室舒张末内径(LVEDD)以及舒张早期及晚期最大血流速度比(E/A),比较不同Hcy水平患者血清颈动脉IMT及LVMI、LVEDD、E/A、LVEF水平,并分析Hcy与上述指标的相关性.结果 74例MHD患者中HHcy发生率为79.73%;HHcy组患者颈动脉IMT及LVMI、LVEDD分别为(1.21±0.29)mm、(152.66±22.94)g/m2、(52.53±5.45)mm,明显高于正常Hcy组的(0.97±0.21)mm、(134.17±20.68)g/m2、(47.37±6.24)mm,E/A、LVEF分别为(1.08±0.22)、(51.23±5.35)%,明显低于正常Hcy组的(1.24±0.35)、(56.04±6.23)%,差异均有统计学意义(P<0.05);相关性分析显示,MHD患者血清Hcy水平与颈动脉IMT、LVMI、LVEDD均呈正相关性,与E/A、LVEF均呈负相关性(P<0.05).结论 MHD患者普遍存在HHcy,血清Hcy水平可反映MHD患者动脉粥样硬化及心脏结构、功能的变化.

Relationship of serum Hcy level with atherosclerosis and cardiac structure and function in hemodialysis patients

Objective To investigate the relationship between serum homocysteine (Hcy) concentration and atherosclerosis, cardiac structure and function in maintenance hemodialysis (MHD) patients. Methods Seventy-four MHD patients treated from January 2015 to October 2016 in our hospital were selected as research subjects. The serum levels of Hcy was detected, and carotid artery intima-media thickness (IMT), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), left ventricular end diastolic diameter (LVEDD), and ratio between early and late dia-stolic transmitral flow velocity (E/A) was determined by ultrasound. Carotid artery IMT, LVMI, LVEDD, E/A, LVEF lev-els in patients with different Hcy levels were compared, and the correlations between Hcy and the above indexes were an-alyzed. Results The incidence of hyperhomocysteinemia (HHcy) was 79.73%among the 74 MHD patients. The carot-id artery IMT, LVMI, LVEDD in HHcy group were (1.21 ± 0.29) mm, (152.66 ± 22.94) g/m2, (52.53 ± 5.45) mm, which were significantly higher than (0.97 ± 0.21) mm, (134.17 ± 20.68) g/m2, (47.37 ± 6.24) mm in normal Hcy group. E/A, LVEF were (1.08 ± 0.22), (51.23 ± 5.35)% in HHcy group, which were significantly lower than (1.24 ± 0.35), (56.04 ± 6.23)%in normal Hcy group. The differences were all statistically significant (P<0.05). Correlation analysis showed that the serum Hcy levels in MHD patients was positively correlated with the carotid artery IMT, LVMI, LVEDD, and it was negatively correlated with E/A, LVEF (P<0.05). Conclusion HHcy in MHD patients is common, and the level of se-rum Hcy can reflect the changes of atherosclerosis and cardiac structure and function in patients with MHD.