血液透析患者高同型半胱氨酸血症、微炎症状态与外周动脉疾病的关系

目的探讨血液透析患者同型半胱氨酸（Hcy）、超敏C反应蛋白（hsCRP）与外周动脉疾病（peripheralarterial disease,PAD）的相关性。方法将踝臂指数（ankle-brachial index,ABI）作为诊断PAD的指标,47例维持性血液透析（MHD）患者,按所测ABI值分为正常组（ABI≥0.9）26例和PAD组（ABI〈0.9）21例,测定两组的血清尿素氮（BUN）、血清肌酐（SCr）、血清白蛋白（Alb）、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、Hcy、hsCRP等指标。结果两组患者透析时间、收缩压（SBP）、舒张压（DBP）、BUN、SCr、TG、TC、LDL-C、HDL-C比较差异无统计学意义。PAD组年龄为（56.0±5.9）岁,正常组年龄为（50.0±8.4）岁,差异有统计学意义（P〈0.05）;PAD组hsCRP为（6.26±2.32）mg/L,正常组hsCRP为（3.46±1.26）mg/L,差异有统计学意义（P〈0.01）;PAD组Hcy为（20.85±7.70）μmol/L,正常组Hcy（13.02±4.88）μmol/L,PAD组Hcy显著高于正常组（P〈0.01）;PAD组Alb为（32.67±3.90）g/L,正常组Alb为（37.54±4.89）g/L,PAD组Alb显著低于正常组（P〈0.01）;相关性分析提示ABI与年龄、hsCRP、Hcy明显负相关,与AlB呈正相关（r值分别为-0.326、-0.615、-0.509、0.425,均P〈0.01）。Logistic回归分析显示hsCRP（OR=2.94,95%CI=1.437～6.112,P〈0.01）、Hcy（OR=1.199,95%CI=1.013～1.419,P〈0.05）是影响ABI的独立相关因素。结论微炎症状态、高同型半胱氨酸血症参与了血液透析患者的动脉硬化和PAD的进程。

Relationship between hyperhomocysteinemia,micro inflammatory status and peripheral arterial disease in hemodialysis patients

Objective To evaluate the correlation among homocysteine（Hcy）,hypersensitivity C-reactive protein（hsCRP） and peripheral arterial disease（PAD） in hemodialysis patients. Methods The ankle-brachial index（ABI） was used to be a diagnostic indicator of PAD.According to ABI,47 hemodialysis patients were randomly divided into two groups,including normal group（n=26,ABI≥0.9） and PAD group（n=21,ABI0.9）.Then,the level of BUN,SCr,Alb,TG,TC,LDL-C,HDL-C,Hcy and hsCRP were measured in both groups. Results There were no significant statistic difference between two groups in dialysis time,SBP,DBP,BUN,SCr,TG,TC,LDL-C and HDL-C.In PAD group,age was（56.0±5.9） years and in normal group,age（50.0±8.4） years,there was statistically significant difference（P0.05）;PAD group showed hsCRP（6.26±2.32） mg/L and normal group hsCRP（3.46±1.26） mg/L,the difference was statistically significant（P0.01）;PAD group showed Hcy（20.85±7.70） μmol/L and normal group Hcy（13.02±4.88） μmol/L,the difference was statistically significant（P0.01）;PAD group had Alb（32.67±3.90） g/L and normal group Alb（37.54±4.89） g/L,the difference was statistically significant（P0.01）.Correlation analysis suggests that ABI and the factors including age,hsCRP levels,Hcy were negatively related while positively related with Alb（respecttively r=-0.326,-0.615,-0.509,0.425,P0.01）.Logistic regression analysis showed that hsCRP（OR=2.94,95%CI=1.437-6.112,P0.01）,Hcy（OR=1.199,95%CI=1.013-1.419,P 0.05） was related factors of the independent effect on ABI. Conclusion The inflammation and state of homocysteine appear to be involved in the process of arteriosclerosis and PAD in blood dialysis patients.