尿毒症血脂代谢紊乱及其对心脏结构和功能的影响

目的 :观察尿毒症患者血脂水平与心脏结构和功能的改变及其相互关系。方法 :测定 86例尿毒症患者和 5 0例对照组的血浆胆固醇 (CHO)、甘油三酯 (TG)、高密度脂蛋白 (HDL)、低密度脂蛋白 (LDL)、载脂蛋白A1(ApoA1)、B(ApoB)及脂蛋白aLp(a) ],并用超声心动图测定患者心脏的左室内径 (LVD)、左房内径 (LAD)、左室后壁厚度 (LVPWT)、室间隔厚度 (IVST)、左室射血分数 (LVEF)等。结果 :尿毒症患者CHO ,TG ,LDL ,ApoB ,Lp(a)较对照组明显增加 (P <0 .0 5 ) ,HDL和ApoA1明显降低 (P <0 .0 5 ) ;尿毒症患者LVD ,LAD ,左室心肌质量指数 (LVMI)明显高于正常对照组 (P <0 .0 1) ,IVST和LVPWT高于正常对照组 (P <0 .0 5 ) ,LVEF明显低于对照组 (P <0 .0 5 )。CHO ,TG ,LDL ,ApoB ,Lp(a)与LVD ,LAD ,LVPWT ,IVST等呈正相关 ,与LVEF呈负相关 ;HDL ,ApoA1与LVD ,LAD ,LVPWT ,IVST呈负相关 ,与LVEF呈正相关。结论 :尿毒症患者血脂水平是影响心脏结构和功能的重要因素 ,降脂治疗可能降低因心血管并发症所致的尿毒症患者的死亡率

Effect of plasma lipid metabolic disorder on the cardiac structure and function in uremic patients

Objective To observe the plasma lipid level, the changes in the cardiac structure and function, and the relationship between them in uremic patients. Methods The levels of cholesterol (CHO), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL),apolipoprotein A1 (ApoA1),apolipoprotein B (ApoB), and lipoprotein (a) in 86 uremic patients and 50 control subjects were detected and the left ventricular diameter (LVD),left atrial diameter (LAD),left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST), and left ventricular ejection fraction (LVEF) were also measured by ultrasonic cardiography. Results The levels of CHO, TG, LDL, ApoB, and Lp(a)increased significantly (P<0.05),while HDL and ApoA1 decreased significantly (P<0.05) in the uremic patients compared with the control subjects. LVD,LAD,LVMI (left ventricular mass index),IVST, and LVPWT increased significantly, while LVEF decreased significantly (P<0.05). The levels of CHO, TG, LDL, ApoB, and Lp(a)were positively correlated to the levels of LVD, LAD, LVPWT, and IVST in the uremic patients, while negatively correlated to the levels of LVEF. The levels of HDL and ApoA1 were negatively correlated to the levels of LVD, LAD, LVPWT, and IVST in the uremic patients, while positively correlated to the levels of LVEF. Conclusion The plasma lipid level is a very important factor which influences the cardiac structure and function in uremic patients. To decrease the plasma lipid level has the possibility to lower the mortality caused by cardiovascular complications in uremic patients.