不同血液净化方式对同型半胱氨酸的清除及其对 - 第三军医大学学报.docVIP

血液净化治疗对尿毒症患者同型半胱氨酸水平以及动脉粥样硬化程度的影响 刘玲 钟玲 冯利平 张玲 （重庆医科大学第二临床学院肾内科，400010） 摘要:目的 观察长期血液净化对维持性血液透析(MHD)患者体内同型半胱氨酸(homocysteine，Hcy)的水平及相应颈动脉内中膜厚度（intima-medial thickness，IMT）和粥样斑块的变化影响。方法 将2006年6月至2007年12月于我院住院或门诊行血液净化治疗的①单纯血液透析组(HD，n=25)，②血液透析合并血液滤过组(HD+HDF，n=30)，③血液透析合并连续性肾脏替代治疗组(HD+CRRT，n=17)，④健康对照组(C，n=25)。分别在为期1年的治疗前后测定3组患者血清Hcy水平，同期作颈动脉彩色多普勒超声检查颈动脉IMT和粥样斑块。结果 MHD患者血清Hcy、IL-6、MCP-1、hs-CRP水平明显高于健康对照组(P0.001)；HDF和CRRT单次治疗后血清Hcy水平显著下降(P0.01)；行HD+HDF和HD+CRRT治疗的MHD患者1年后血清Hcy水平低于HD治疗组(P0.05)，同时颈动脉IMT值、粥样硬化斑块的面积小于HD治疗组；Pearson检测显示MHD患者血清Hcy水平与颈动脉IMT和粥样硬化斑块的面积呈正相关(r=0.46，r=0.52)。结论 Hcy是心血管疾病的独立危险因素，HDF和CRRT治疗能显著清除Hcy，改善MHD患者动脉粥样硬化的发生及发展，提高生存率。 关键词 血液净化；动脉粥样硬化；同型半胱氨酸；治疗 Effect of long-term blood purification on homocysteine level and atherosclerosis LIU Ling, ZHONG Ling, FENG Li-ping, ZHANG Ling (Division of Nephrology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China) Abstract: Objective To investigate the influence of long-term blood purification on atherosclerosis (AS) in maintenance hemodialysis (MHD) patients by measuring serum levels of homocysteine (Hcy) and carotid artery intima-medial thickness (IMT). Methods Seventy-two MHD patients visiting our hospital from June 2006 to December 2007, according to their blood purification mode, were assigned to three groups: hemodialysis (HD, n=25), hemodialysis+hemodiafiltration (HD+HDF, n=30), hemodialysis+continuous renal replacement therapy (HD+CRRT, n=17). Another 25 healthy subjects served as controls. Serum Hcy was detected before and after one-year treatment and meanwhile color Doppler ultrasonography was perfomed to check IMT of carotid artery and atheromatous plaques. Results The serum levels of Hcy, IL-6, MCP-1, hs-CRP in MHD patients were siginificantly higher than those in healthy controls (P0.001). The serum levels of Hcy decreased after the treatment of HDF and CRRT (P0.01). After one-year treatment, IMT and area of carotid artery plaques in HDF and HD+CRRT groups were lo