CAJ | 학술논문

目的：探讨维持性血液透析（MHD）患者妊娠相关血浆蛋白A（PAPP-A）水平与心脏结构和功能的关系。方法选择86例透析病程大于或等于6个月的M HD患者为研究对象，根据有无心血管疾病（CVD）事件分为非心血管病变（M HD-nCVD）组50例和心血管病变（M HD-CVD）组36例，以40例年龄相当的健康体检者作为健康对照组，采用酶联免疫吸附试验（ELISA）检测血清 PAPP-A 水平和超声心动图检测心脏结构与功能，分析血清PAPP-A水平和超声心动图检测指标的相关性。结果 M HD-nCVD组和M HD-CVD组患者血清PAPP-A水平分别为（4．26±1．72）、（7．83±2．16）mIU/L ，明显高于健康对照组的（1．77±0．51）mIU/L ，差异有统计学意义（P＜0．05），MHD-CVD组患者血清PAPP-A水平明显高于MHD-nCVD组，差异有统计学意义（P＜0．05）。相关性分析显示：MHD患者PAPP-A与左心室心肌质量指数（LVMI）呈正相关（r＝0．484，P＜0．05），与左室射血分数（EF）呈负相关（r＝-0．379，P＜0．05）。结论 M HD患者存在血清妊娠相关血浆A水平增高，血清PAPP-A水平可反映LVMI及左心室结构和功能变化，对左心室肥厚及左心室功能的评估有预测作用。
목적：탐토유지성혈액투석（MHD）환자임신상관혈장단백A（PAPP-A）수평여심장결구화공능적관계。방법선택86례투석병정대우혹등우6개월적M HD환자위연구대상，근거유무심혈관질병（CVD）사건분위비심혈관병변（M HD-nCVD）조50례화심혈관병변（M HD-CVD）조36례，이40례년령상당적건강체검자작위건강대조조，채용매련면역흡부시험（ELISA）검측혈청 PAPP-A 수평화초성심동도검측심장결구여공능，분석혈청PAPP-A수평화초성심동도검측지표적상관성。결과 M HD-nCVD조화M HD-CVD조환자혈청PAPP-A수평분별위（4．26±1．72）、（7．83±2．16）mIU/L ，명현고우건강대조조적（1．77±0．51）mIU/L ，차이유통계학의의（P＜0．05），MHD-CVD조환자혈청PAPP-A수평명현고우MHD-nCVD조，차이유통계학의의（P＜0．05）。상관성분석현시：MHD환자PAPP-A여좌심실심기질량지수（LVMI）정정상관（r＝0．484，P＜0．05），여좌실사혈분수（EF）정부상관（r＝-0．379，P＜0．05）。결론 M HD환자존재혈청임신상관혈장A수평증고，혈청PAPP-A수평가반영LVMI급좌심실결구화공능변화，대좌심실비후급좌심실공능적평고유예측작용。
Objective To evaluate the relationship between pregnancy-associated plasma protein A (PAPP-A) and cardiac structure and function in patients with maintenance hemodialysis (M HD) .Methods A total of 86 M HD patients ,with course of treatment for at least 6 months ,were divided into non-cardiovascular disease (CVD) group (M HD-nCVD group ,n=50) and cardi ovascular disease group (M HD-CVD group ,n=36) according to the state of CVD ,and 40 age-marched health subjects were enrolled as health control group .Serum levels of PAPP-A were deter-mined by ELISA ,and cardiac structure and function were evaluated by echocardiography .The correlations between serum level of PAPP-A and indexes of echocardiogram were analyzed .Results Serum levels of PAPP-A in both MHD-nCVD group and MHD-CVD group ,which were (4 .26 ± 1 .72) and (7 .83 ± 2 .16)mIU/L respectively ,were significantly higher than that of control group ,which was (1 .77 ± 0 .51)mIU/L (P<0 .05) .Serum level of PAPP-A in M HD-CVD group was significantly higher than that of M HD-nCVD group ( P< 0 .05 ) .Correlation analysis showed that level of PAPP-A in patients with M HD was positively correlated with left ventricular mass index (LV-MI ,r=0 .484 ,P<0 .05) ,and negatively correlated with left ventricular ejection fraction (LVEF ,r= -0 .379 ,P<0 .05) .Conclusion Serum level of PAPP-A in patients with MHD might be high ,which could reflect LVMI and left ventricular structure and function ,and could evaluate left ventricular hypertrophy and left ventricular function .