维持性血液透析患者血清β2微球蛋白与左心室结构和功能的关系

摘要

目的 回顾性观察维持性血液透析(maintenance hemodialysis,MHD)患者血清β2微球蛋白(β2-microglobulin,β2-MG)水平及心脏形态、结构和功能的变化,分析β2-MG与左心室结构和功能的关系,初步探讨血清β2-MG水平对预测MHD患者左心室肥厚的作用.方法 选择2016年1月至2016年6月青岛市城阳区人民医院血液净化中心规律血液透析治疗的患者147例.按照纳入与排除标准筛选出受试对象.入选出符合要求的71例MHD患者作为研究对象.根据左心室后壁厚度(left ventricular wall,LVPWT)和室间隔厚度(interventricular septum,IVST)同时≥12 mm作为诊断左心室肥厚的标准,将受试对象分为左心室肥厚组和非左心室肥厚组.采用酶联免疫吸附技术(ELISA法)检测血清β2-MG水平;采用飞利浦iu22超声诊断仪评定心脏形态、结构和功能.结果 ①MHD患者左心室肥厚组血清β2-MG水平、C-反应蛋白水平均显著高于非左心室肥厚组(P＜0.05).②MHD患者左心室肥厚组的左房内径、左室内径、室间隔厚度和左心室后壁厚度均升高,而左心室射血分数下降(P＜0.05).③相关性分析显示:血清β2-MG水平与左室内径(r=0.36,P＜0.01)、左心室后壁厚度(r=0.30,P＜0.05)呈正相关,与血红蛋白呈负相关(r=-0.30,P＜0.05).多元线性回归分析显示,左室内径、左心室后壁厚度和血红蛋白是β2-MG的独立相关因素(P＜0.05).结论 MHD患者血清β2-MG水平与左心室结构和功能改变密切相关,它可能在MHD患者心血管事件的发生、发展过程中起重要作用.本研究提示血清β2-MG水平可能有助于预测MHD患者左心室肥厚的严重程度.%Objective To explore the role of serum β2-microglobulin (β2-MG) levels in predicting left ventricular hypertrophy (LVH) in maintenance hemodialysis (MHD) patients by retrospectively investigating the serum levels of β2-MG and changes in cardiac structure and function,and analyze the relationship between β2-MG with left ventricular structure and function.Methods Totally 147 MHD patients in Blood Purification Center of Qingdao Chengyang People's Hospital from January 2016 to June 2016 were selected.According to the inclusion and exclusion,71 MHD patients were enrolled in this study.LVH was diagnosed when both left ventricular wall thickness (LVPWT) and interventricular septum thickness (IVST) were ≥12 mm.The subjects were divided into LVH group and non-LVH group.Serum β2-MG levels were measured by ELISA.Cardiac structure and function were assessed by two-dimensional echocardiography.Results The serum levels of β2-MG and C reactive protein in MHD patients with LVH were significantly higher than in those without LVH (P＜0.05).The left ventricular diameter (LVD),left atrial diameter (LAD),IVST and LVPWT were significandy higher,and the left ventricular ejection fraction (LVEF) was significantly lower in MHD patients with LVH (P＜0.05).β2-MG levels were positively correlated with LVD and LVPWT (P＜0.05),but negatively with hemoglobin (P＜0.05).Multiple regression results showed that LVD,LVPWT and hemoglobin were associated with β2-MG levels independently (P＜0.05).Conclusions Elevated levels of β2-MG in MHD patients had a relationship with cardiac structure and function,which may play a key role in the occurrence of cardiovascular events.This study suggests that serum β2-MG levels may be helpful in predicting the severity of LVH in MHD patients.