不同血液净化方式对同型半胱氨酸的清除及其对动脉粥样硬化的影响.DOC

作者简介：刘玲，女，重庆市人，博士，主治医师，主要从事血液净化治疗方面的研究。电话：（023）E-mail:ll10131@ 通信作者：张玲，E-mail: Lindazhang8508@ 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(Hcy)水平，及相应颈动脉内中膜厚度（IMT）和粥样斑块的变化影响。方法 将72例尿毒症患者按不同血液净化方式分为： = 1 \* GB3 ①单纯血液透析（HD）组， = 2 \* GB3 ②血液透析合并血液滤过（HD+HDF）组， = 3 \* GB3 ③血液透析合并连续性肾脏替代治疗（HD+CRRT）组。分别在为期一年的治疗前后测定三组患者血清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，并设健康对照组作对照。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 period blood purification clear homocysteine and influence on atherosclerosis LIU Ling, ZHONG Ling, FENG Li-ping, ZHANG Ling. Division of Nephrology, the Second Affiliated Hospital, Chongqing University of Medical Science 400010 China [Abstract] Objective To investigate the influence of long period blood purification treatment on atherosclerosis (AS) in patients with maintained hemodialysis(MHD) by measuring the serum levels of homocysteine (Hcy) and carotid artery intima-medial thickness (IMT). Methods During one year 72 patients with MHD were assigned to receive the treatment of different modes of blood purification = 1 \* GB3 ①hemodialysis（HD）, = 2 \* GB3 ② hemodialysis combined by hemodiafiltration（HD+HDF）, = 3 \* GB3 ③ hemodialysis combined by continuous renal replacement therapy（HD+CRRT）.Serum Hcy and color Doppler ultrasonography in carotid artery were detected before and after one year treatment. Results The levels of Serum Hcy、IL-6、MCP-1、hs-CRP in MHD patients were siginificantly higher than those in healthy controls (P 0.001). The levels of Serum Hcy decreased after the treatment of HDF and CRRT ( P0.01) . After one –year treating IMT and the area of carotid artery plaques in patien