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
2010年
1期
35-39
,共5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%Microinflammtory state%Malnutrition%Anemia%Left ventricle
目的 探讨终末期肾脏病维持性血液透析患者超敏C反应蛋白与贫血、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(超敏C反应蛋白＞3 mg/L)和非微炎症组(超敏C反应蛋白≤3 mg/L),检测100例维持性血液透析患者超敏C反应蛋白、血清白蛋白、三酰甘油、总胆固醇、脂蛋白(a)、血肌酐、血红蛋白及红细胞压积;用彩色超声多普勒显像仪测定左心房前后径、左心室前后径、左心窜舒张期后壁厚度、室间隔厚度、左室射血分数,舒张早期左室充盈峰速率与心房收缩期左室充盈峰速率比值、计算左心室质量指数,测不同时间(5次)血压并取均值,分析超敏C反应蛋白与上述各参数间的关系.结果 (1)微炎症组患者血红蛋白、红细胞压积、血清白蛋白脂蛋白(a)与非微炎症组比较差异有统计学意义(P分别＜0.01,＜0.05);(2)微炎症组患者左心房前后径、左心室前后径、左心室舒张期后壁厚度、室间隔厚度、左心室质量指数、左室射血分数、舒张早期左室克盈峰速率与心房收缩期左室充盈峰速率比值与非微炎症组比较差异也有统计学意义(P分别＜0.05,＜0.01);(3)相关分析结果表明,血清超敏C反应蛋白浓度与血红蛋白、红细胞压积、血清白蛋白呈负相关(r分别=-0.283、-0.308、-0.387,P分别＜0.05、＜0.01),与脂蛋白(a)呈正相关(r=0.427,P＜0.01);与左心室前后径、室间隔厚度、左心室质量指数呈显著正相关(r分别=0.277、0.394、0.307,P均＜0.05);与左室射血分数、舒张早期左室充盈峰速率与心房收缩期左室充盈峰速率比值呈显著负相关(r分别=-0.386、-0.543,P均＜0.01);(4)血清超敏C反应蛋白、血红蛋白、红细胞压积、Kt/V值、血清白蛋白、脂蛋白(a)、收缩压、脉压是维持性血液透析患者心脏结构及功能异常危险因素.结论 维持性血液透析患者存在微炎症状态时血清超敏C反应蛋门升高.血清超敏C反应蛋白可预测维持性血液透析患者的贫血程度、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患者超敏C反應蛋白與貧血、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(超敏C反應蛋白＞3 mg/L)和非微炎癥組(超敏C反應蛋白≤3 mg/L),檢測100例維持性血液透析患者超敏C反應蛋白、血清白蛋白、三酰甘油、總膽固醇、脂蛋白(a)、血肌酐、血紅蛋白及紅細胞壓積;用綵色超聲多普勒顯像儀測定左心房前後徑、左心室前後徑、左心竄舒張期後壁厚度、室間隔厚度、左室射血分數,舒張早期左室充盈峰速率與心房收縮期左室充盈峰速率比值、計算左心室質量指數,測不同時間(5次)血壓併取均值,分析超敏C反應蛋白與上述各參數間的關繫.結果 (1)微炎癥組患者血紅蛋白、紅細胞壓積、血清白蛋白脂蛋白(a)與非微炎癥組比較差異有統計學意義(P分彆＜0.01,＜0.05);(2)微炎癥組患者左心房前後徑、左心室前後徑、左心室舒張期後壁厚度、室間隔厚度、左心室質量指數、左室射血分數、舒張早期左室剋盈峰速率與心房收縮期左室充盈峰速率比值與非微炎癥組比較差異也有統計學意義(P分彆＜0.05,＜0.01);(3)相關分析結果錶明,血清超敏C反應蛋白濃度與血紅蛋白、紅細胞壓積、血清白蛋白呈負相關(r分彆=-0.283、-0.308、-0.387,P分彆＜0.05、＜0.01),與脂蛋白(a)呈正相關(r=0.427,P＜0.01);與左心室前後徑、室間隔厚度、左心室質量指數呈顯著正相關(r分彆=0.277、0.394、0.307,P均＜0.05);與左室射血分數、舒張早期左室充盈峰速率與心房收縮期左室充盈峰速率比值呈顯著負相關(r分彆=-0.386、-0.543,P均＜0.01);(4)血清超敏C反應蛋白、血紅蛋白、紅細胞壓積、Kt/V值、血清白蛋白、脂蛋白(a)、收縮壓、脈壓是維持性血液透析患者心髒結構及功能異常危險因素.結論 維持性血液透析患者存在微炎癥狀態時血清超敏C反應蛋門升高.血清超敏C反應蛋白可預測維持性血液透析患者的貧血程度、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 탐토종말기신장병유지성혈액투석환자초민C반응단백여빈혈、영양불량급좌심실공능간적관계.방법 장환자분위미염증조(초민C반응단백＞3 mg/L)화비미염증조(초민C반응단백≤3 mg/L),검측100례유지성혈액투석환자초민C반응단백、혈청백단백、삼선감유、총담고순、지단백(a)、혈기항、혈홍단백급홍세포압적;용채색초성다보륵현상의측정좌심방전후경、좌심실전후경、좌심찬서장기후벽후도、실간격후도、좌실사혈분수,서장조기좌실충영봉속솔여심방수축기좌실충영봉속솔비치、계산좌심실질량지수,측불동시간(5차)혈압병취균치,분석초민C반응단백여상술각삼수간적관계.결과 (1)미염증조환자혈홍단백、홍세포압적、혈청백단백지단백(a)여비미염증조비교차이유통계학의의(P분별＜0.01,＜0.05);(2)미염증조환자좌심방전후경、좌심실전후경、좌심실서장기후벽후도、실간격후도、좌심실질량지수、좌실사혈분수、서장조기좌실극영봉속솔여심방수축기좌실충영봉속솔비치여비미염증조비교차이야유통계학의의(P분별＜0.05,＜0.01);(3)상관분석결과표명,혈청초민C반응단백농도여혈홍단백、홍세포압적、혈청백단백정부상관(r분별=-0.283、-0.308、-0.387,P분별＜0.05、＜0.01),여지단백(a)정정상관(r=0.427,P＜0.01);여좌심실전후경、실간격후도、좌심실질량지수정현저정상관(r분별=0.277、0.394、0.307,P균＜0.05);여좌실사혈분수、서장조기좌실충영봉속솔여심방수축기좌실충영봉속솔비치정현저부상관(r분별=-0.386、-0.543,P균＜0.01);(4)혈청초민C반응단백、혈홍단백、홍세포압적、Kt/V치、혈청백단백、지단백(a)、수축압、맥압시유지성혈액투석환자심장결구급공능이상위험인소.결론 유지성혈액투석환자존재미염증상태시혈청초민C반응단문승고.혈청초민C반응단백가예측유지성혈액투석환자적빈혈정도、영양상태,병가용래평개좌심실결구화공능,차시좌심실결구화공능이상적독립위험인소.
Objective To study microinflammatory state of end-stage renaldisease patients in mainrained hemodialysis(MHD) and the relationship between microinfl-ammatory state 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-mi-croinflammation group (hs-CRP≤3 mg/L)and microinflammation group( ha-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 determined.The levels of hemoglobin (Hb) and hematocrit (Hct) were detected.The left atrial (LAD) and ventricular diameter (LVD),interventricular septum thickness(IVST),left ventricular posterior wall thickness (LVPW),left ventricular ejective fraction(FT),ratio of E/A were measured by color doppler echocardiography,and left ventricular mass index(LVMI) was caculated.Blood pressure was measured in different 5 stages,and their relation were analysed.Results ( 1 )The levels of Hb,Hct,Alb in microinflammation group were lower than those in contol group( P ＜ 0.05,＜0.01),the level of LP(a) was higher than that in the non-microinflammation group (P ＜0.05);(2)The levels of LAD,LVD,LVPW,IVST,LVMI in elevated microinflammation group were higher than those in control group( P ＜ 0.05,＜ 0.01 ),the levels of EF and E/A were lower than those in non-microinflammation group ( P ＜ 0.05,＜ 0.01 );(3) Blood serum hs-CRP concentration was correlated negatively with the level of Hb,Hct ( P ＜ 0.05),Alb( P ＜ 0.05 ) and inversely with LP(a) ( P ＜ 0.05).Blood serum hs-CRP concentration was correlated positively with LVD,IVST,LVMI (P ＜ 0.05) and inversely with EF,E/A (P＜0.05);(4)hs-CRP,Hb,Hct,Kt/V,Alb,Lp(a),SBP,PP were risk factors of abnormal left ventricular structure and function.Conclusion In patients undergoing maintenance hemodialysis,persistent increase of hs-CRP indicates the presence of microinflammation,hs-CRP might be a marker for the anemia,nutrition status and left ventricular structure and function.Elevated hs-CRP is an independent risk factor of abnormal left ventricolar structure and function.
