老年维持性血液透析患者血清P选择素、瘦素、脑钠肽与心脏结构和功能改变的关系

摘要

目的 探讨老年维持性血液透析(HD)患者血清P选择素(PS)、瘦素、脑钠肽(BNP)与心脏结构和功能改变的关系.方法 选择老年维持性HD患者58例(观察组)、正常健康者58例(对照组),检测两组血清C反应蛋白(CRP)、BNP、PS、瘦素水平；应用超声心动图检测两组左心室舒张末内径(LVDd)、左心室收缩末内径(LVDS)、室间隔厚度(IVST)、左心室后壁厚度(LVPW)、左心房内径(LAD)、左心室射血分数(LVEF),计算左心室心肌质量指数(LVMt).结果 观察组血清CRP、BNP、PS、瘦素水平均高于对照组(P均＜0.05)；观察组IVST、LVPW、LAD、LVMI均高于对照组(P均＜0.05),LVEF低于对照组(P＜0.05).观察组血清瘦素水平与LVDd、LVPW、LVMI、CRP、BNP呈正相关(r分别为0.317、0.256、0.309、0.358、0.328,P均＜0.05),与LVEF呈负相关(r=-0.276,P＜0.05),与LVDs、LAD、IVST无相关性；血清PS水平与LVDd、LVMI、CRP、BNP呈正相关(r分别为0.271、0.315、0.372、0.321,P均＜0.05),与LVEF呈负相关(r=-0.306,P＜0.05),与LVDs、LVPW、LAD、IVST无相关性.结论 老年维持性HD患者体内存在慢性微炎症状态及心脏结构和功能的改变,其心脏结构和功能异常可能与血清瘦素、PS和BNP水平升高有关.%Objective To study the relativity of cardiac structure and function, P-selectin(PS) , leptin in old patients with hemodialysis. Methods 58 old uremic patients treated in our blood purification center and 58 normal subjects in this study were selected. The serum BNP, C-reactive protein(CRP) , PS and leptin levels in the department of clinical laboratory were detected. The left ventricular diameter( LVD) , left atrial diameter( LAD) , left ventricular posterior wall thickness (LVPW) , interventricular septal thickness (I VST) and left ventricular ejection fraction (LVEF) were evatualed with ultrasonic cardiography. Serum BNP, CRP, PS, leptin levels and the consequence of ultrasonic cardiography were compared in the two groups. The relationship between serum BNP, CRP, PS, leptin levels and cardiac structure and function in these patients were analyzed by partial correlation model. Results In old uremic patients, serum BNP, CRP, leptin levels were significantly higher than those of control group (all P < 0. 01). The PS level was higher than that of control group (P < 0.05). The level of LEMI was significantly higher than that of control group(P <0.01 ). The levels of IVST, LVPW, LAD, LVEF were higher than those of control group ( all P < 0. 05 ) . Serum leptin level was positively correlated with the levels of LVDd, LVPW, LVMI, CRP, BNP (all P <0. 05), and was negative correlated with the level of LVEF(P < 0. 05 ) . Serum PS level was positively correlated with the levels of LVDd, LVMI, CRP, BNP( all P < 0. 05) , and was negative correlated with the level of LVEF(P <0.05). Conclusions Chronic micro inflammatory reaction and chronic cardiac insufficiency are the major changes of old patients with maintenance hemodialysis, and those chages are closely related to PS, leptin and BNP.