【作者】 刘小菁；

【导师】 夏天；

【作者基本信息】 天津医科大学 ， 内科学， 2009， 硕士

【摘要】 目的:同型半胱氨酸(homocysteine,Hcy)是一种的非必需氨基酸,肾脏是其重要的代谢场所。慢性肾功能不全患者血浆Hcy水平常明显升高,且血浆Hcy升高程度与肾功能的下降相平行。Hcy被认为是心血管疾病的独立危险因素,高同型半胱氨酸血症与终末期肾脏病(end stage renal kidney,ESRD)患者心血管疾病的发生率和病死率有关。一氧化氮(nitro oxide,NO)是评价血管内皮功能的一个重要指标,NO在慢性肾功能不全的发生、发展过程中的地位目前尚未明确,且ESRD时Hcy与NO的关系尚不清楚。本实验通过对尿毒症组和腹膜透析组患者血浆、腹透液Hcy和血清、腹透液NO水平的检测,评价腹膜透析对尿毒症患者血浆Hcy和血清NO的影响,探讨腹膜透析在防治ESRD心血管并发症中的作用。方法:选取尿毒症患者60例,分为尿毒症组和持续性非卧床腹膜透析组(continuous ambulatory peritoneal dialysis,CAPD组),各30例;健康体检者20例为对照组。三组间年龄性别相匹配(见表1-2)。两实验组患者近一个月内均无显性水肿,临床状况稳定,无腹腔内和其他部位感染,无严重的心力衰竭、胃肠道出血、活动性肝病、肿瘤、创伤及手术等合并症。对照组均经体检排除感染、高脂血症、高血压、糖尿病、心脑血管疾病及肝肾疾病。留取各组受试者的血浆和血清,测定Hcy、NO和其他生化指标,其中高压液相色谱技术测定血浆和腹透液Hcy水平,硝酸酶还原法测定血清和腹透液NO水平。结果:对照组血浆Hcy水平为8.73±1.20μmol/L,尿毒症组Hcy水平为45.10±15.65μmol/L,CAPD组为35.96±16.86μmol/L,腹透液的Hcy水平为9.76±7.25umol/L。统计学分析后,尿毒症组和CAPD组的Hcy均高于对照组(P＜0.01),尿毒症组Hcy高于CAPD组(P＜0.05)。尿毒症组血压正常患者血浆Hcy水平为32.17±7.87μmol/L,尿毒症组伴高血压患者血浆Hcy水平为51.56±14.57μmol/L。两组间比较差异有统计学意义(P＜0.01)。CAPD组血压正常患者血浆Hcy水平为23.97±7.42μmol/L,CAPD组伴有高血压患者血浆Hcy水平为41.96±17.16μmol/L。两者比较差异有统计学意义(P＜0.01)。对照组血清NO水平为53.72±11.51μmol/L,尿毒症组患者血清NO水平为182.78±45.32μmol/L,CAPD组血清NO水平为171.60±33.55μmol/L,腹透液的NO水平为120.29±41.80μmol/L。进行统计学分析后,尿毒症组和CAPD组的血清NO均高于对照组(P＜0.01)。CAPD组的血清NO水平低于尿毒症组,但是两组间比较差异无统计学意义(P＞0.05)。结论:尿毒症组和CAPD组血浆Hcy水平均高于对照组,然而CAPD组低于尿毒症组。尿毒症组和CAPD组伴有高血压者的血浆Hcy高于血压正常者。ESRD患者血浆Hcy与年龄、高血压成正相关关系。尿毒症组和CAPD组血清NO水平均高于对照组。CAPD组血清NO水平低于尿毒症组,但是差异无统计学意义。腹膜透析可以清除尿毒症患者的血浆Hcy,从而降低尿毒症患者的高同型半胱氨酸血症,腹膜透析也可以清除尿毒症患者的血清NO,但是两组之间比较无统计学意义。近年来的研究认为慢性肾功能衰竭的患者Hcy的升高是发生心血管系统疾病的独立危险因素之一。机体内过量的NO也会造成组织细胞的损伤。高同型半胱氨酸血症在尿毒症患者和腹膜透析患者中普遍存在,对于其高同型半胱氨酸血症和高NO血症的治疗有待于进一步的研究。更多还原

【Abstract】 Objetcive:Homocysteine(Hcy) is a non-essential amino acid.Kidney is an important metabolism place.In the recent years,homocysteine is considered as an independent risk factor of cardiovascular disease.The plasma homocysteine level is often significantly higher in the patients of chronic renal failure.And the increased plasma Hcy level is parallelled with the renal function decline.Homocysteine is considered an independent risk factor of cardiovascular disease.Hyperhomocys-teinemia is related to the cardiovascular disease incidence and mortality of the patients of the end-stage renal disease(ESRD).Nitric oxide(NO) is an important index of the evaluation of endothelial function.It is not yet clear that NO plays a part in the occurrence and development of chronic renal failure.And the relationship between Hcy and NO is not clear in the ESRD patients.This experiment is to explore the effect of peritoneal dialysis on plasma homocysteine and nitric oxide(NO) level of uremic patients,through detecting the serum Hcy and NO levels of the the uremia group and peritoneal dialysis group.To discuss the role of peritoneal dialysis on the prevention and treatment of cardiovascular complications in the ESRD patients.Methods:The uremia patients were collected.They were divided into the uremia group and the continuous ambulatory peritoneal dialysis(CAPD) group.The each group was 30 cases.The healthy adult were 20 cases.And they were considered as the control group.The age and gender among the three groups were matched.The patients of uremia group and CAPD group had not dominant edema,peritoneal infection and other infections,and clinical situation was stable.They had not serious heart failure, gastrointestinal bleeding,active liver disease,cancer,trauma and surgery factors.The control group had been considered by the medical examination to exclude infection, hyperlipidemia,hypertension,diabetes,cardiovascular,cerebrovascular diseases and liver and kidney disease.The plasma and serum of each group were colleted.The Hcy levels of the plasma and peritoneal dialysis fluid were measured by high performance liquid chromatography analysis.The NO levels of the serum and peritoneal dialysis fluid were measured by enzyme nitrate reduction.Results:The plasma Hcy level of the control group was 8.73±1.20μmol/L.The plasma Hcy level of the uremia group was 45.10±15.65μmol/L.The plasma Hcy level of the CAPD group was 35.96±16.86μmol/L.The Hcy level of peritoneal dialysis fluid was 9.76±7.25 umol/L.After the statistical analysis,the Hcy of the uremia group and CAPD group were higher than that of the control group(P＜0.01). The Hcy of the uremia group was higher than that of the CAPD group(P＜0.05).The plasma Hcy level of the uremia group with normal blood pressure was 32.17±7.87μmol/L,but the plasma Hcy level of the uremia group with hypertension was 51.56±14.57μmol/L.The differences between the two groups were statistically significant(P＜0.01).The plasma Hcy level of the CAPD group with normal blood pressure was 23.97±7.42μmol/L,but the plasma Hey level of the CAPD group with hypertension was 41.96±17.16μmol/L.The differences between the two groups were statistically significant(P＜0.01).The serum NO level of the control group was 53.72±11.51μmol/L.The serum NO level of the uremia group was 182.78±45.32μmol/L.The serum NO level of the CAPD group was 171.60±33.55μmol/L.The NO level of peritoneal dialysis fluid was 120.29±41.80μmol/L.After the statistical analysis,The NO level of uremia and CAPD group group were higher than that of the control group(P＜0.01).The NO level of the CAPD group was lower than that of the uremia group,but comparison between the two groups was no significant difference(P＞0.05).Conclusions:Compared with the control group,the plasma Hcy levels of the uremia group and CAPD group were higher than that of the control group.But the Hey level of CAPD group was lower than that of the uremia group.The plasma Hcy level of the uremia group and CAPD group with hypertension was higher than that with normal blood pressure.The plasma Hcy level of the ESRD patients was positively correlated with age and hypertension.Compared with the control group,the serum NO levels of uremia group and CAPD group were statistically significant,and were higher than that of the control group.And the NO level of the CAPD group was lower than that of the uremia group.But the difference between the two groups was no statistical significance.Peritoneal dialysis can remove plasma homocysteine of the uremic patients,and lower the hyperhomocysteinemia of the uremia patients.Peritoneal dialysis can remove serum NO of the uremic patients,but the difference between was no statistical significance.In the recent years,some reseraches suggested that the Hcy level of the chronic renal failure patients was an independent risk factor for cardiovascular disease.The excessive NO levels of the body were damaged to tissue and cells.Hyperhomocysteinemia was prevalent in patients of the uremia and peritoneal dialysis patients.The treatment for its hyperhomocysteinemia and the higher NO levels needs further study.更多还原