中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2010年
8期
840-843
,共4页
尿毒症%血液透析%微炎症状态%营养不良%贫血%左心室
尿毒癥%血液透析%微炎癥狀態%營養不良%貧血%左心室
뇨독증%혈액투석%미염증상태%영양불량%빈혈%좌심실
Uremia%Hemodialysis%Microinflammatory status%Malnutrition%Anemia%Left ventricle
目的 探讨终末期肾脏病维持性血液透析(MHD)患者超敏C-反应蛋白(hs-CRP)与贫血、营养不良及左心室功能间的关系.方法 将患者分为微炎症组(hs-CRP>3 mg/L)和非微炎症组(hs-CRP≤3mg/L),检测100例MHD患者hs-CRP、血清白蛋白(Alb)、甘油三酯(TG)、总胆固醇(TC)、脂蛋白(a)[Lp(a)]、血肌酐(SCr)及血红蛋白(Hb)、红细胞比客(Hct);用彩色超声多普勒显像仪测量左心房前后径(LAD)、左心室前后径(LVD)、左心室舒张期后壁厚度(LVPW)、室间隔厚度(IVST)、左心室射血分数(LVEF),舒张早期左心室充盈峰速率(E)与心房收缩期左心室充盈峰速率(A)比值(E/A)、计算左心室质量指数(LVMI),测不同时间5次血压并取均值,分析hs-CRP与上述各参数间的关系.结果 ①微炎症组Hb、Hct、Alb明显低于非微炎症组(t=2.83,P<0.01;t=2.34,P<0.05;t=5.30,P<0.01),LP(a)高于非微炎症组(t=2.68,P<0.05);②微炎症组LAD、LVD、LVPW、IVST、LVMI明显高于非微炎症组(P<0.05或P<0.01),而EF、E/A比值下降(t=2.06,P<0.05;t=2.98,P<0.01);③相关分析表明,血清hs-CRP浓度与Hb、Hct、Alb呈负相关[r值分别为-0.283(P<0.05)、-0.308(P<0.05)、-0.387(P<0.01)],与LP(a)呈正相关(r=0.427,P<0.01),与LVD、IVST、LVMI呈显著正相关(r值分别为0.277、0.394、0.307,P均<0.05),与EF、E/A呈显著负相关(r值分别为-0.386、-0.543,P均<0.01);④hs-CRP、Hb、Hct、Kt/V、Alb、Lp(a)、SBP、PP是MHD患者心脏结构及功能异常危险因素.结论 MHD患者存在微炎症状态,hs-CRP升高,hs-CRP可预测MHD患者的贫血程度、营养状态,并可用来评价左心室结构和功能.且是左心室结构和功能异常的独立危险因素.
目的 探討終末期腎髒病維持性血液透析(MHD)患者超敏C-反應蛋白(hs-CRP)與貧血、營養不良及左心室功能間的關繫.方法 將患者分為微炎癥組(hs-CRP>3 mg/L)和非微炎癥組(hs-CRP≤3mg/L),檢測100例MHD患者hs-CRP、血清白蛋白(Alb)、甘油三酯(TG)、總膽固醇(TC)、脂蛋白(a)[Lp(a)]、血肌酐(SCr)及血紅蛋白(Hb)、紅細胞比客(Hct);用綵色超聲多普勒顯像儀測量左心房前後徑(LAD)、左心室前後徑(LVD)、左心室舒張期後壁厚度(LVPW)、室間隔厚度(IVST)、左心室射血分數(LVEF),舒張早期左心室充盈峰速率(E)與心房收縮期左心室充盈峰速率(A)比值(E/A)、計算左心室質量指數(LVMI),測不同時間5次血壓併取均值,分析hs-CRP與上述各參數間的關繫.結果 ①微炎癥組Hb、Hct、Alb明顯低于非微炎癥組(t=2.83,P<0.01;t=2.34,P<0.05;t=5.30,P<0.01),LP(a)高于非微炎癥組(t=2.68,P<0.05);②微炎癥組LAD、LVD、LVPW、IVST、LVMI明顯高于非微炎癥組(P<0.05或P<0.01),而EF、E/A比值下降(t=2.06,P<0.05;t=2.98,P<0.01);③相關分析錶明,血清hs-CRP濃度與Hb、Hct、Alb呈負相關[r值分彆為-0.283(P<0.05)、-0.308(P<0.05)、-0.387(P<0.01)],與LP(a)呈正相關(r=0.427,P<0.01),與LVD、IVST、LVMI呈顯著正相關(r值分彆為0.277、0.394、0.307,P均<0.05),與EF、E/A呈顯著負相關(r值分彆為-0.386、-0.543,P均<0.01);④hs-CRP、Hb、Hct、Kt/V、Alb、Lp(a)、SBP、PP是MHD患者心髒結構及功能異常危險因素.結論 MHD患者存在微炎癥狀態,hs-CRP升高,hs-CRP可預測MHD患者的貧血程度、營養狀態,併可用來評價左心室結構和功能.且是左心室結構和功能異常的獨立危險因素.
목적 탐토종말기신장병유지성혈액투석(MHD)환자초민C-반응단백(hs-CRP)여빈혈、영양불량급좌심실공능간적관계.방법 장환자분위미염증조(hs-CRP>3 mg/L)화비미염증조(hs-CRP≤3mg/L),검측100례MHD환자hs-CRP、혈청백단백(Alb)、감유삼지(TG)、총담고순(TC)、지단백(a)[Lp(a)]、혈기항(SCr)급혈홍단백(Hb)、홍세포비객(Hct);용채색초성다보륵현상의측량좌심방전후경(LAD)、좌심실전후경(LVD)、좌심실서장기후벽후도(LVPW)、실간격후도(IVST)、좌심실사혈분수(LVEF),서장조기좌심실충영봉속솔(E)여심방수축기좌심실충영봉속솔(A)비치(E/A)、계산좌심실질량지수(LVMI),측불동시간5차혈압병취균치,분석hs-CRP여상술각삼수간적관계.결과 ①미염증조Hb、Hct、Alb명현저우비미염증조(t=2.83,P<0.01;t=2.34,P<0.05;t=5.30,P<0.01),LP(a)고우비미염증조(t=2.68,P<0.05);②미염증조LAD、LVD、LVPW、IVST、LVMI명현고우비미염증조(P<0.05혹P<0.01),이EF、E/A비치하강(t=2.06,P<0.05;t=2.98,P<0.01);③상관분석표명,혈청hs-CRP농도여Hb、Hct、Alb정부상관[r치분별위-0.283(P<0.05)、-0.308(P<0.05)、-0.387(P<0.01)],여LP(a)정정상관(r=0.427,P<0.01),여LVD、IVST、LVMI정현저정상관(r치분별위0.277、0.394、0.307,P균<0.05),여EF、E/A정현저부상관(r치분별위-0.386、-0.543,P균<0.01);④hs-CRP、Hb、Hct、Kt/V、Alb、Lp(a)、SBP、PP시MHD환자심장결구급공능이상위험인소.결론 MHD환자존재미염증상태,hs-CRP승고,hs-CRP가예측MHD환자적빈혈정도、영양상태,병가용래평개좌심실결구화공능.차시좌심실결구화공능이상적독립위험인소.
Objective To study microinflammatory status in patients of end-stage renal disease undergoing maintained hemodialysis (MHD) and the relationship between microinfl-ammatory status of end-stage renal disease and anemia, malnutrition, left ventricular function in maintained hemodialysis patients. Methods One hundred patients undergoing hemodialysis were divided into non-microinflammation group ( hs-CRP ≤ 3 mg/L) and microinflammation group ( hs-CRP > 3 mg/L) . The serum levels of hs-CRP, albumin, triglyceride ( TG) , total cholesterol(TC) , lipoprotein(a) [LP( a)] and serum creatinine ( SCr) were measured. The levels of hemoglobin (Hb) and hematocrit (Hct) were measured. The left atrial (LAD)and ventricular diameter(LVD) ,interventricular septum thickness (IVST) ,left ventricular posterior wall thickness (LVPW) ,left ventricular ejective fraction (EF), ratio of E/A were measured by color Doppler echocardiography, and left ventricular mass index (LVMI) was calculated. Blood pressure was measured in different 5 stages, and their relation were analysed. Results ①The levels of Hb, Hct, Alb in microinflammation group were lower than those in the control group(t =2. 83 ,P <0.01; t=2.34, P<0.05;t = 5.30,P <0.01, respectively), the level of LP(a) was higher than that in the non-microinflammation group(t = 2. 68, P < 0. 05 ). ②The levels of LAD, LVD, LVPW, IVST, LVMI in the elevated microinflammation group were higher than those in the control group (P < 0.05), the levels of EF and E/A were lower than those in the non-microinflammation group ( P < 0. 05 ) .③ Blood serum hs-CRP concentration was negatively correlated with the level of Hb,Hct(r= -0. 283,P <0. 05;r = -0. 308,P <0.05;r = -0.387,P< 0. 01, respectively ) , and positively correlated with LP ( a ) ( r = 0.427, P < 0. 05 ) . Blood serum hs-CRP concentration was positively correlated with LVD,IVST,LVMI (P <0. 05) and negatively correlated with EF,E/A (P<0.05). ④hs-CRP, Hb, Hct, Kt/V, Alb, Lp(a) ,SBP and PP were risk factors of abnormal left ventricular structure and function. Conclusions In patients undergoing maintenance hemodialysis, the persistent increase of hs-CRP indicates the presence of microinflammation hs-CRP might.be a indicator of the anemia, nutrition status and left ventricular structure and function. Elevated hs-CRP is an independent risk factor of abnormal left ventricular structure and function.
