缺血修饰白蛋白水平与血液透析患者心血管疾病的相关分析

目的探讨维持性血液透析（maintenance hemodialysis，MHD）患者缺血修饰白蛋白（ischemia modified albumin，IMA）水平的变化及其与心血管疾病（cardiovasculardisease，CVD）的关系。方法回顾性分析86例MHD患者的临床及实验室结果。根据患者是否发生CVD分为CVD组和非CVD组，分析2组患者的临床特点和实验室检查结果；所有患者均完成颈动脉和心脏彩超检查；采用白蛋白结合试验（albumin cobalt binding，ACB）测定患者IMA水平。采用Spearman相关分析IMA与其他指标的相关性；用二分类Logistic回归方法分析IMA与CVD的相关性。结果86例MHD患者IMA平均水平高于对照组[（95．24±18．06）kU／L比（56．58±12．36）kU／L，P〈0．05]；CVD组患者IMA水平高于非CVD组患者[（115．27±16．38）kU／L比（81．64±19．82）kU／L，P〈0．013；IMA水平与低密度脂蛋白胆固醇（10wdensity lipoprotein cholesterol，LDL-C）、肌钙蛋白T（cardiactroponin T，cTnT）、超敏C反应蛋白（hinghsensitivityC-reactiveprotein，hs-CRP）、白细胞介素6（interleukin6，IL-6）、左室心肌重量指数（lef tventricular index，LVMI）、颈动脉内膜中层厚度（ca—rotidintima-mediathickness，IMT）呈正相关（r=0．402，P=0．036；r=0．584，P=0．021；r：0．514，P=0．023；r=0．396，P=0．042；r=0．610，P=0．002；r=0．537，P=0．022），与Hb、Alb、左室射血分数（1eftventricular ejection fraction，LVEF）呈负相关（r=-0．387，P=0．026、r=-0．573，P〈0．01）1、r=-0．496，P=0．018）；二分类logistic回归分析显示，IMA、hs—CRP是MHD患者CVD的危险因素。结论MHD患者IMA水平显著升高，合并CVD患者升高更为明显，IMA是MHD患者CVD的独立危险因素，可以作为MHD患者CVD早期诊断标志物。

Correlation of plasma ischemia modified albumin with cardiovascular disease in maintenance hemodialysis patients

Objective To study the relationship between cardiovageular diseases（CVD） and Is- chemia modified albumin in maintenance hemodialysis patients. Methods 86 cases were retrospectively analyzed. The clinical data were recorded at the beginning. Meanwhile, Serum IMA were detected. The relationships between serum IMA level and some laboratory parameters were analyzed. The risk factors of cardiovageular diseases were investigated through Logistic regression analysis. Results Serum IMA level increased in maintenance hemodialysis patients compared with that in normal controls[（95.24 ± 18. 06）kU/L VS （56. 58 ± 12. 36） kU/L,P〈0. 05]. The patients in CVD group had significantly higher IMA level （P〈0. 001 ） ; IMA was positively correlated with LDL-C. cTnT, hs CRP, IL-6, LVMI, IMT（r = 0. 402, P = 0.036 r = 0. 584, P = 0.021 r = 0. 514, P = 0. 023） r = 0. 396, P = 0. 042, r = 0. 610,P = 0. 002, r = 0. 537, P = 0. 022）. It was negatively correlated with Hb, Alb, LVEF （r = - 0. 387, P = 0. 026, r = - 0. 573, P〈0. 001, r = - 0. 496, P = 0. 018） ; Multivariable logistic regression analysis showed that IMA,hs-CRP were independent risk factors for CV-D. Conclusions Serum IMA level is significantly higher in maintenance hemodialysis patients. IMA is an independent risk factor of CVD in maintenance hemodialysis patients.