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目的研究腹膜透析患者血浆不对称二甲基精氨酸(ADMA)水平与左心功能的关系及腹膜透析对血浆ADMA水平的影响。方法选取内蒙古医科大学附属医院终末期肾脏病(ESRD,慢性肾功能不全尿毒症期)患者60例,同期健康志愿者30例(正常对照组),共计90例,其中男性54例,女性36例,平均年龄53.7岁。ESRD患者分持续性不卧床腹膜透析(CAPD,时间均大于3个月)治疗30例(CAPD治疗组)和保守治疗患者30例(保守治疗组)。3组年龄、性别相匹配。收集入组者的相关临床及实验室资料。使用酶联免疫吸附分析(ELISA)测定所有入组者血浆及CAPD治疗组患者腹膜透析液中ADMA含量;并对入组者行超声心动图检测,根据Devereux公式计算左心室质量(LVM)及左心室质量指数(LVMI)。统计学分析3组差异。结果 CAPD治疗组患者血浆ADMA水平为(0.125±0.076)μmol/L,保守治疗组血浆ADMA水平为(0.214±0.121)μmol/L,正常对照组血浆ADMA水平为(0.035±0.291)μmol/L,3组间差异有显著统计学意义(P=0.000)。CAPD治疗组血浆ADMA水平与左心室射血分数(LVEF)呈负相关(r=-0.562,P=0.001),且与LVMI、LVM、左心室舒张末期内径(LVDd)、左心房内径(LAD)呈正相关(P<0.05)。保守治疗组比CAPD治疗组患者LVMI高(P=0.01),且有左心室肥厚(LVH)的保守治疗组患者比有LVH的CAPD治疗组患者血浆ADMA水平高(P<0.05)。CAPD治疗组腹膜透析液ADMA水平为(0.146±0.077)μmol/L,CAPD治疗组腹膜透析液的ADMA水平与LVEF呈正相关(r=0.367,P=0.046),与LVMI呈负相关(r=-0.369,P=0.045)。结论 ESRD保守治疗组患者血浆ADMA水平与CAPD治疗组血浆ADMA水平均比正常对照组高,说明慢性ESRD存在ADMA的清除功能不全;CAPD治疗组血浆ADMA水平与LVH呈正相关,可以提示ADMA在CAPD患者左心室重构过程中可能起重要作用;保守治疗组比CAPD治疗组患者LVMI高,在腹膜透析液中检测到ADMA,说明腹膜透析可以在一定程度上清除血浆ADMA,腹膜透析对尿毒症患者心血管并发症的发生是一种保护性治疗。
Objective To investigate the relationship between plasma asymmetric dimethylarginine (ADMA) levels and left ventricular function in patients undergoing peritoneal dialysis and the effect of peritoneal dialysis on plasma ADMA levels. Methods Sixty patients with end-stage renal disease (ESRD, uremia of chronic renal insufficiency) and 30 healthy volunteers (normal control group) were enrolled in the Affiliated Hospital of Inner Mongolia Medical University in total 90 cases, including 54 males and 36 females , The average age of 53.7 years old. ESRD patients were divided into continuous ambulatory peritoneal dialysis (CAPD> 3 months), 30 patients (CAPD group) and 30 conservative patients (conservative group). 3 groups of age, gender match. Collect the relevant clinical and laboratory data of the participants. The levels of ADMA in peritoneal dialysis fluid were measured by enzyme-linked immunosorbent assay (ELISA) in all subjects and CAPD-treated patients. The patients underwent echocardiography, and the left ventricular mass (LVM) and left Ventricular mass index (LVMI). Statistical analysis of three groups differences. Results The level of plasma ADMA in patients with CAPD was (0.125 ± 0.076) μmol / L, that in patients with conservative therapy was (0.214 ± 0.121) μmol / L, and that in patients with normal controls was (0.035 ± 0.291) μmol / L, The difference between the three groups was statistically significant (P = 0.000). The level of plasma ADMA in CAPD group was negatively correlated with left ventricular ejection fraction (LVEF) (r = -0.562, P = 0.001) and was positively correlated with LVMI, LVM, left ventricular diastolic dimension (LAD) (P <0.05). Patients in the conservative treatment group had higher LVMI than those in the CAPD group (P = 0.01), and those in the conservative treatment group with left ventricular hypertrophy (LVH) had higher levels of plasma ADMA than patients with LVH in the CAPD group (P <0.05). The level of ADMA in peritoneal dialysis fluid of patients in CAPD group was (0.146 ± 0.077) μmol / L, the level of ADMA in peritoneal dialysis fluid of CAPD group was positively correlated with LVEF (r = 0.367, P = 0.046) and negatively correlated with LVMI (r = 0.369, P = 0.045). Conclusions Plasma ADMA levels in ESRD conservative treatment group are higher than those in normal control group, indicating that ADMA clearance in chronic ESRD patients is incomplete. There is a positive correlation between plasma ADMA levels and LVH in CAPD treatment group, which may indicate ADMA in CAPD patients Left ventricular remodeling may play an important role in the conservative treatment group than CAPD treatment group patients LVMI, ADMA detected in peritoneal dialysis solution, indicating that peritoneal dialysis can be cleared to some extent, plasma ADMA, peritoneal dialysis patients with uremia heart The occurrence of vascular complications is a protective treatment.