CAJ | 학술논문

目的：观察慢性肾脏病（CKD）患者血浆肾上腺髓质素（adrenomedullin，ADM）的变化，探讨血浆ADM水平与心室重构的关系。方法纳入2009年1月~2010年7月解放军第253医院CKD患者60例，其中32例患者为CKD5期（A组），28例患者为CKD3期（B组）；同期纳入60例体检肾功能正常者作为对照组（C组）。采用放射免疫法测定各组血浆ADM水平，同时应用ATL公司HDI-5000型彩色多普勒超声诊断仪测定心功能指标，包括左室舒张末内径（LVDd）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、左心室射血分数（LVEF）、舒张早期和晚期最大血流速度比（E/A），计算左心室重量指数（LVMI），采用直线相关及多元回归法对ADM和各项心功能指标进行相关分析。结果 A组血浆ADM水平最高[（35.22±28.22）pg/ml]，其次为B组[（10.60±4.41）pg/ml]，C组最低[（8.71±2.55）pg/ml]，三组间两两存在统计学差异（P＜0.05）；A组、B组和C组LVDd、IVST、LVPWT和LVMI依次降低， LVEF和E/A值依次升高，A组和B组均与C组存在统计学差异，但A组与B组之间无统计学差异。血浆ADM与LVDd、IVST、LVPWT、LVMI呈正相关，与LVEF和E/A值呈负相关。在剔除了性别、年龄、血压、血脂、血红蛋白等因素后，血浆ADM仍是LVPWT、LVDd、E/A的独立影响因素（P分别为0.014、0.035、0.05）。结论CKD患者血浆ADM水平显著升高，高ADM水平是CKD患者心室重构的独立危险因素之一。
목적：관찰만성신장병（CKD）환자혈장신상선수질소（adrenomedullin，ADM）적변화，탐토혈장ADM수평여심실중구적관계。방법납입2009년1월~2010년7월해방군제253의원CKD환자60례，기중32례환자위CKD5기（A조），28례환자위CKD3기（B조）；동기납입60례체검신공능정상자작위대조조（C조）。채용방사면역법측정각조혈장ADM수평，동시응용ATL공사HDI-5000형채색다보륵초성진단의측정심공능지표，포괄좌실서장말내경（LVDd）、실간격후도（IVST）、좌심실후벽후도（LVPWT）、좌심실사혈분수（LVEF）、서장조기화만기최대혈류속도비（E/A），계산좌심실중량지수（LVMI），채용직선상관급다원회귀법대ADM화각항심공능지표진행상관분석。결과 A조혈장ADM수평최고[（35.22±28.22）pg/ml]，기차위B조[（10.60±4.41）pg/ml]，C조최저[（8.71±2.55）pg/ml]，삼조간량량존재통계학차이（P＜0.05）；A조、B조화C조LVDd、IVST、LVPWT화LVMI의차강저， LVEF화E/A치의차승고，A조화B조균여C조존재통계학차이，단A조여B조지간무통계학차이。혈장ADM여LVDd、IVST、LVPWT、LVMI정정상관，여LVEF화E/A치정부상관。재척제료성별、년령、혈압、혈지、혈홍단백등인소후，혈장ADM잉시LVPWT、LVDd、E/A적독립영향인소（P분별위0.014、0.035、0.05）。결론CKD환자혈장ADM수평현저승고，고ADM수평시CKD환자심실중구적독립위험인소지일。
Objective To observe the changes of plasma adrenomedullin (ADM) and discuss the relationship between ADM and ventricular remodeling in the patients with chronic kidney disease (CKD). Methods The CKD patients (n=60) were chosen from the 253rd Hospital of Chinese PLA from Jan. 2009 to Jul. 2010, and divided into group A (with stage 5 CKD, n=32) and group B (with stage 3 CKD, n=28). At the same time 60 cases with normal renal function were chosen as group C (control group). The level of plasma ADM was detected by using radioimmunoassay. The cardiac function indexes, including LVDd, IVST, LVPWT, LVEF and E/A were determined by applying color Doppler ultrasonic diagnostic apparatus. LVMI was calculated. The correlation between ADM and cardiac function indexes were analyzed by using the methods of linear correlation and multiple regression. Results The level of ADM was the highest [(35.22±28.22) pg/mL] in group A, followed by group B [(10.60±4.41) pg/mL] and the lowest in group C [(8.71±2.55) pg/mL], and the pairwise comparison among three groups showed statistical difference (P<0.05). LVDd, IVST, LVPWT and LVMI decreased and LVEF and E/A increased in order in group A, group B and group C, and there was statistical difference between group A or group B and group C, but no statistical difference between group A and group B. ADM was positively correlated to LVDd, IVST, LVPWT and LVMI, and negatively correlated to LVEF and E/A. After excluding the factors of sex, age, blood pressure, blood fat and hemoglobin, ADM still was the independent influence factor of LVPWT, LVDd and E/A (P=0.014, P=0.035, P=0.05). Conclusion The level of ADM increases significantly in CKD patients, which is one of independent risk factors of ventricular remodeling.