国际移植与血液净化杂志
國際移植與血液淨化雜誌
국제이식여혈액정화잡지
INTERNATIONAL JOURNAL OF TRANSPLANTATION AND HEMOPURIFICATION
2009年
6期
31-35
,共5页
魏莉莉%岑俊%顾谊铮%伏春明%王雪英%王传祥%余杰
魏莉莉%岑俊%顧誼錚%伏春明%王雪英%王傳祥%餘傑
위리리%잠준%고의쟁%복춘명%왕설영%왕전상%여걸
脂联素%瘦素%胰岛素抵抗%心脏%血液透析
脂聯素%瘦素%胰島素牴抗%心髒%血液透析
지련소%수소%이도소저항%심장%혈액투석
Adiponectin%Leptin%Isulin resistance%Heart%Hemodialysis
目的 探讨维持性血液透析患者脂肪因子(脂联素、瘦素)、胰岛素抵抗水平与心脏结构和功能的相关性.方法 选择79例维持性血液透析患者和16名健康对照者,测定血清脂联素、瘦素、血糖、胰岛素并计算稳态模型胰岛素抵抗指数;行超声心动图测定左心房内径、左心室舒张末内径、左心室收缩末内径、室间隔厚度、左心室后壁厚度、左心室射血分数等,计算左心室心肌重量指数,并将维持性血液透析患者分成左心室肥厚组(43例)和非左心室肥厚组(36例).结果 维持性血液透析组患者的血清脂联素、瘦素、胰岛素、稳态模型胰岛素抵抗指数与健康对照组比较差异有统计学意义(P<0.05);维持性血液透析组左心室心肌重量指数、左心室舒张末内径、室间隔厚度、左心室后壁厚度、左心房内径、舒张早期和晚期最大血流速度比、左心室射血分数与健康对照组比较差异也有统计学意义(P分别<0.05、0.01).维持性血液透析组左心室肥厚的发生率为54.4%,左心室射血分数<50%的发生率为10.2%、舒张早期和晚期最大血流速度比<1的发生率为71.9%;左心室肥厚组的血清瘦素、胰岛素、稳态模型胰岛素抵抗指数、左心室心肌重茸指数、血清脂联素与非左心室肥厚组比较差异有统计学意义(P分别<0.05、0.01).维持性血液透析组患者血清脂联素与血清瘦素、胰岛素、稳态模型胰岛素抵抗指数、左心室心肌重量指数、室间隔厚度、左心室后壁厚度呈显著负相关(r分别=-0.770、-0.693、-0.530、-0.483、-0.374、-0.320,P分别<0.05、0.01);血清瘦素与胰岛素、稳态模型胰岛素抵抗指数呈显著正相关(r分别=0.620、0.620,P均<0.01);血清瘦素、胰岛素、稳态模型胰岛素抵抗指数分别与左心室心肌重量指数、室间隔厚度、左心室后壁厚度呈显著正相关(r分别=0.513、0.381、0.149、0.617、0.359、0.293、0.483、0.359、0.320,P分别<0.05、<0.01);血清瘦素、胰岛素、稳态模型胰岛素抵抗指数分别与舒张早期和晚期最大血流速度比、左心室射血分数呈负相关(,分别=-0.225、-0.111、-0.215、-0.750、-0.198、-0.049,P均<0.05).结论 维持性血液透析患者脂肪因子(血清脂联素、瘦素)与胰岛素抵抗密切相关,并相互协同共同参与了维持性血液透析患者心血管并发症的发生和发展.
目的 探討維持性血液透析患者脂肪因子(脂聯素、瘦素)、胰島素牴抗水平與心髒結構和功能的相關性.方法 選擇79例維持性血液透析患者和16名健康對照者,測定血清脂聯素、瘦素、血糖、胰島素併計算穩態模型胰島素牴抗指數;行超聲心動圖測定左心房內徑、左心室舒張末內徑、左心室收縮末內徑、室間隔厚度、左心室後壁厚度、左心室射血分數等,計算左心室心肌重量指數,併將維持性血液透析患者分成左心室肥厚組(43例)和非左心室肥厚組(36例).結果 維持性血液透析組患者的血清脂聯素、瘦素、胰島素、穩態模型胰島素牴抗指數與健康對照組比較差異有統計學意義(P<0.05);維持性血液透析組左心室心肌重量指數、左心室舒張末內徑、室間隔厚度、左心室後壁厚度、左心房內徑、舒張早期和晚期最大血流速度比、左心室射血分數與健康對照組比較差異也有統計學意義(P分彆<0.05、0.01).維持性血液透析組左心室肥厚的髮生率為54.4%,左心室射血分數<50%的髮生率為10.2%、舒張早期和晚期最大血流速度比<1的髮生率為71.9%;左心室肥厚組的血清瘦素、胰島素、穩態模型胰島素牴抗指數、左心室心肌重茸指數、血清脂聯素與非左心室肥厚組比較差異有統計學意義(P分彆<0.05、0.01).維持性血液透析組患者血清脂聯素與血清瘦素、胰島素、穩態模型胰島素牴抗指數、左心室心肌重量指數、室間隔厚度、左心室後壁厚度呈顯著負相關(r分彆=-0.770、-0.693、-0.530、-0.483、-0.374、-0.320,P分彆<0.05、0.01);血清瘦素與胰島素、穩態模型胰島素牴抗指數呈顯著正相關(r分彆=0.620、0.620,P均<0.01);血清瘦素、胰島素、穩態模型胰島素牴抗指數分彆與左心室心肌重量指數、室間隔厚度、左心室後壁厚度呈顯著正相關(r分彆=0.513、0.381、0.149、0.617、0.359、0.293、0.483、0.359、0.320,P分彆<0.05、<0.01);血清瘦素、胰島素、穩態模型胰島素牴抗指數分彆與舒張早期和晚期最大血流速度比、左心室射血分數呈負相關(,分彆=-0.225、-0.111、-0.215、-0.750、-0.198、-0.049,P均<0.05).結論 維持性血液透析患者脂肪因子(血清脂聯素、瘦素)與胰島素牴抗密切相關,併相互協同共同參與瞭維持性血液透析患者心血管併髮癥的髮生和髮展.
목적 탐토유지성혈액투석환자지방인자(지련소、수소)、이도소저항수평여심장결구화공능적상관성.방법 선택79례유지성혈액투석환자화16명건강대조자,측정혈청지련소、수소、혈당、이도소병계산은태모형이도소저항지수;행초성심동도측정좌심방내경、좌심실서장말내경、좌심실수축말내경、실간격후도、좌심실후벽후도、좌심실사혈분수등,계산좌심실심기중량지수,병장유지성혈액투석환자분성좌심실비후조(43례)화비좌심실비후조(36례).결과 유지성혈액투석조환자적혈청지련소、수소、이도소、은태모형이도소저항지수여건강대조조비교차이유통계학의의(P<0.05);유지성혈액투석조좌심실심기중량지수、좌심실서장말내경、실간격후도、좌심실후벽후도、좌심방내경、서장조기화만기최대혈류속도비、좌심실사혈분수여건강대조조비교차이야유통계학의의(P분별<0.05、0.01).유지성혈액투석조좌심실비후적발생솔위54.4%,좌심실사혈분수<50%적발생솔위10.2%、서장조기화만기최대혈류속도비<1적발생솔위71.9%;좌심실비후조적혈청수소、이도소、은태모형이도소저항지수、좌심실심기중용지수、혈청지련소여비좌심실비후조비교차이유통계학의의(P분별<0.05、0.01).유지성혈액투석조환자혈청지련소여혈청수소、이도소、은태모형이도소저항지수、좌심실심기중량지수、실간격후도、좌심실후벽후도정현저부상관(r분별=-0.770、-0.693、-0.530、-0.483、-0.374、-0.320,P분별<0.05、0.01);혈청수소여이도소、은태모형이도소저항지수정현저정상관(r분별=0.620、0.620,P균<0.01);혈청수소、이도소、은태모형이도소저항지수분별여좌심실심기중량지수、실간격후도、좌심실후벽후도정현저정상관(r분별=0.513、0.381、0.149、0.617、0.359、0.293、0.483、0.359、0.320,P분별<0.05、<0.01);혈청수소、이도소、은태모형이도소저항지수분별여서장조기화만기최대혈류속도비、좌심실사혈분수정부상관(,분별=-0.225、-0.111、-0.215、-0.750、-0.198、-0.049,P균<0.05).결론 유지성혈액투석환자지방인자(혈청지련소、수소)여이도소저항밀절상관,병상호협동공동삼여료유지성혈액투석환자심혈관병발증적발생화발전.
Objective To analyze the relatonship between adipocytokines(adiponectin, leptin), in-sulin resistunce and cardiac structure and function in patients undergoing maintenance hemodialysis(MHD). Methods The level of adiponecfin (ADPN), leptin(LEP), fasting glucose(FBG) and fasting insulin (FINS) were measured in 79 MHD patents and 16 healthy individuals. The left atrial diameter(LAD), left ventricular end" diastolic diameter(LVDd), left ventricular end -systolic diameter(LVDs), interventricular septal thickness(IVST), left ventricular posterior wall thickness(LVPWT) and left ventricular ejection frac-tion(LVEF) were also detected by ultrasonic cardiography. Calculated HOMA -IR, left ventricular mass index (LVMI) by established formulasThe 79 MHD patents were divided into two groups: left ventricular hypertro-phy(LVH) group and Non -LVH group. Results The average serum ADPN, LEP, HOMA-IR were signifi-cantly higher in MHD patients than those in the healthy individuals(P < 0.05) ;LVMI, LVDd, IVST, LVW PT, LADincreasedsignificantly (P < 0.05, < 0.01), whileLVEF, E/Adecreasedmarkedly (P < 0.01).54.4% of patients with MHD had left ventricular hypertrophy. Serum LEP, FINS,HOMA-IR, LVMI in the LVH group was significantly higher than those in Non-LVH group(P <0.05, < 0.01). While serum ADPN in the LVH group was significantly lower than that in Non-LVH group(P < 0.01). The level of ADPN was negatively correlated with the levels of LEP, FINS, HOMA -IR, LVMI, IVST and LVPWT in MHD patients (P < 0.01) ;the level of LEP was positivsly correlated with those of FINS、HOMA-IR. The levels of LEP, FINS, HOMA-IR were positivsly correlated with the levels of LVMI, IVST, LVPWT,but negatively correlated with the levels of E/A, LVEF(P <0.05, <0.01). Conclusion Adipocytokines (ADPN,LEP) are closely correlated with insulin resistance. They are probably involved in presence and progression of cardiovascular complications in MHD patients.
