标题：慢性肾衰血液透析患者容量超负荷与其炎症因子、心功能以及血脂水平的相关性

      作者：丘宝珍    (梅州市人民医院肾内科，广东 梅州 514031)

      卷次： 2018年29卷7期

      【摘要】 目的 分析慢性肾衰血液透析患者容量超负荷与其炎症因子、心功能以及血脂水平的关系。方法 选取2015年2月至2016年8月于梅州市人民医院接受血液透析治疗且经肺超声诊断确诊为容量超负荷的的慢性肾衰患者 36例记为容量超负荷组，另取同期未出现容量超负荷的慢性肾衰血液透析患者 36例记为正常组。分别采用酶联免疫吸附法以及超声心动检测仪检测两组患者的炎症因子水平以及心功能，同时检测两组患者血压以及血脂水平，并进行比较分析。结果 正常组患者血清白细胞介素-6 (IL-6)、可溶性细胞间黏附分子-1(sICAM-1)以及超敏C反应蛋白(hs-CRP)水平分别为(15.3±1.7) pg/mL、(355.3±95.8) ng/mL、(2.2±0.6) mg/L，均明显低于容量超负荷组的(19.2±2.9) pg/mL、(504.5±125.9) ng/mL、(4.6±1.1) mg/L，差异均有统计学意义(均P<0.05)。正常组患者左心房内径(LAD)、左室舒张末内径(LVDd)、左室收缩末内径(LVDs)水平分别为(36.1±7.7) mm、(49.5±9.2) mm、(38.1±4.9) mm，均明显低于容量超负荷组的(40.3±9.2) mm、(54.7±12.1) mm、(41.5±7.3) mm，而正常组SV(72.4±18.3) mL、EF (62.5±16.7)%、FS (33.0±12.6)%水平均明显高于容量超负荷组的(64.2±16.1) mL、(55.1±13.9)%、(27.0±11.2)%，两组比较差异有统计学意义(均P<0.05)。正常组患者收缩压、舒张压水平分别为(130.4±12.6) mmHg、(74.8±7.4) mmHg，均明显低于容量超负荷组患者的(142.5±15.7) mmHg、(90.2±11.5) mmHg，差异均有统计学意义(P<0.05)。正常组患者的总胆固醇、甘油三酯以及低密度脂蛋白水平分别为(3.8±0.3) mmol/L、(1.2±0.3) mmol/L、(2.7±0.2) mmol/L，均明显低于容量超负荷组的(4.7±0.3) mmol/L、(2.2±0.4) mmol/L、(3.4±0.3) mmol/L，差异均有统计学意义(均P<0.05)。经Spearman相关性分析发现：容量超负荷与各项炎症因子、血脂指标、LAD、LVDd、LVDs均呈显著正相关关系，与SV、EF、FS均呈显著负相关关系。结论 慢性肾衰血液透析患者容量超负荷会导致患者的炎症因子水平发生改变，并严重影响患者心功能，同时会影响血脂指标水平。
      【关键词】 慢性肾功能衰竭；血液透析；容量超负荷；炎症因子；心功能
      【中图分类号】 R692.5 【文献标识码】 A 【文章编号】 1003—6350（2018）07—0923—04

Association of volume overload with inflammatory factors, cardiac function and blood lipid levels in hemodialysispatients with chronic renal failure.
QIU Bao-Zhen. Department of Internal Medicine, Meizhou People's Hospital, Meizhou514031, Guangdong, CHINA
【Abstract】 Objective To analyze the relationship between volume overload and inflammatory factors, cardiacfunction, blood lipid level in hemodialysis patients with chronic renal failure (CRF). Methods Thirty-six patients withCRF of volume overload who were treated with hemodialysis and diagnosed by pulmonary ultrasonography in our hospitalfrom February 2015 to August 2016 were selected as the volume overload group, and other 36 patients with CRF withoutvolume overload in the the same period were recorded as normal group. The level of inflammatory factors, cardiac func-tion, blood pressure and blood lipid between two groups were detected by enzyme linked immunosorbent assay (ELISA)and ultrasonic cardiogram. Results The levels of serum interleukin-6 (IL-6), soluble intercellular adhesion molecule-1(sICAM-1) and hypersensitive C-reactive protein (hs-CRP) were respectively (15.3 ± 1.7) pg/mL, (355.3 ± 95.8) ng/mL,(2.2±0.6) mg/L in normal group, which were significantly lower than (19.2±2.9) pg/mL, (504.5±125.9) ng/mL, (4.6±1.1) mg/L in volume overload group (all P<0.05). The levels of left atrial dimension (LAD), left ventricular end diastolicdimension (LVDd), left ventricular end-systolic dimension (LVDs) were respectively (36.1±7.7) mm, (49.5±9.2) mm,(38.1±4.9) mm in normal group, which were significantly lower than (40.3±9.2) mm, (54.7±12.1) mm, (41.5±7.3) mm involume overload group, but the levels of stroke volume (SV), ejection fraction (EF), fractional shortening (FS) were(72.4±18.3) mL, (62.5±16.7)%, (33.0±12.6)% in normal group, which were significantly higher than (64.2±16.1) mL,(55.1±13.9)%, (27.0±11.2)% in volume overload group (all P<0.05). The levels of systolic pressure, diastolic blood pres-sure were respectively (130.4 ± 12.6) mmHg, (74.8 ± 7.4) mmHg in normal group, which were significantly lower than(142.5±15.7) mmHg, (90.2±11.5) mmHg in volume overload group (all P<0.05). The levels of total cholesterol, triglycer-ides, and low density lipoprotein were respectively (3.8±0.3) mmol/L, (1.2±0.3) mmol/L, (2.7±0.2) mmol/L in normalgroup, which were significantly lower than (4.7±0.3) mmol/L, (2.2±0.4) mmol/L, (3.4±0.3) mmol/L in volume overloadgroup, P<0.05. Spearman correlation analysis showed that volume overload was correlated positively with inflammatoryfactors, blood lipid indexes, LAD, LVDd, LVDs, and it was negatively correlated with SV, EF, FS. Conclusion volumeoverload chronic renal failure patients undering hemodialysis can result in changes in patient's level of