Effect of long-term blood purification on homocysteine level and atherosclerosis in maintenance hemodialysis patients

刘玲; 钟玲; 冯利平; 张玲

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Effect of long-term blood purification on homocysteine level and atherosclerosis in maintenance hemodialysis patients

更新时间：2026-01-09

- Effect of long-term blood purification on homocysteine level and atherosclerosis in maintenance hemodialysis patients
- Journal of Army Medical University Vol. 31, Issue 11, Pages: 1102-1105(2009)
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  CLC： R36;R459.5;R692.5
- Published：2009
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刘玲,钟玲,冯利平,张玲.血液净化治疗对尿毒症患者同型半胱氨酸水平以及动脉粥样硬化程度的影响[J].陆军军医大学学报(原第三军医大学学报),2009,31(11):1102-1105.

　LIU Ling,ZHONG Ling,FENG Li-ping,ZHANG Ling.Effect of long-term blood purification on homocysteine level and atherosclerosis in maintenance hemodialysis patients[J].J Amry Med Univ (J Third Mil Med Univ),2009,31(11):1102-1105.
刘玲,钟玲,冯利平,张玲.血液净化治疗对尿毒症患者同型半胱氨酸水平以及动脉粥样硬化程度的影响[J].陆军军医大学学报(原第三军医大学学报),2009,31(11):1102-1105. DOI：

　LIU Ling,ZHONG Ling,FENG Li-ping,ZHANG Ling.Effect of long-term blood purification on homocysteine level and atherosclerosis in maintenance hemodialysis patients[J].J Amry Med Univ (J Third Mil Med Univ),2009,31(11):1102-1105. DOI：

摘要

目的观察长期血液净化对维持性血液透析(maintenance hemodialysis，MHD)患者体内同型半胱氨酸(homocysteine，Hcy)的水平及相应颈动脉内中膜厚度（intima-medial thickness，IMT）和粥样斑块面积变化的影响。方法将2006年6月至2007年12月于我院住院或门诊行血液净化治疗的72例尿毒症患者(男性38例，女性34例)按不同血液净化方式分为单纯血液透析组(HD组，n=25)，血液透析合并血液滤过组(HD+HDF组，n=30)，血液透析合并连续性肾脏替代治疗组(HD+CRRT组，n=17)，健康对照组(C组，n=25)。分别在为期1年的治疗前后测定3组患者血清Hcy水平，同期做颈动脉彩色多普勒超声检查颈动脉IMT和粥样斑块面积。结果 MHD患者血清Hcy、IL-6、MCP-1、hs-CRP水平明显高于健康对照组(P0.01)；HDF组和CRRT组单次治疗后血清Hcy水平显著下降(P0.01)；行HD+HDF和HD+CRRT治疗的MHD患者1年后血清Hcy水平明显低于HD治疗组(P0.05)。同时颈动脉IMT值、粥样硬化斑块的面积小于HD治疗组；Pearson相关分析显示MHD患者血清Hcy水平与颈动脉IMT和粥样硬化斑块的面积呈显著正相关(r=0.46

P0.05; r=0.52

P0.01)。结论 Hcy是心血管疾病的独立危险因素，HD+HDF和HD+CRRT治疗能显著清除Hcy，改善MHD患者动脉粥样硬化的发生及发展，提高生存率。

Abstract

Objective To investigate the influence of long-term blood purification on atherosclerosis (AS) in maintenance hemodialysis (MHD) patients by measuring serum levels of homocysteine (Hcy) and carotid artery intima-medial thickness (IMT). Methods Seventy-two MHD patients visiting our hospital from June 2006 to December 2007

according to their blood purification mode

were assigned to three groups: hemodialysis(HD

n=25)

hemodialysis+hemodiafiltration (HD+HDF

n=30)

hemodialysis+continuous renal replacement therapy (HD+CRRT

n=17). Another 25 healthy subjects served as controls. Serum Hcy was detected before and after one-year treatment and meanwhile color Doppler ultrasonography was performed to check IMT of carotid artery and atheromatous plaques. Results The serum levels of Hcy

IL-6

MCP-1

hs-CRP in MHD patients were significantly higher than those in healthy controls (P0.01). The serum levels of Hcy decreased after the treatment of HDF and CRRT (P0.01). After one-year treatment

IMT and area of carotid artery plaques in HDF and HD+CRRT groups were lower than those in HD group. Serum level of Hcy was associated with carotid artery IMT and area of carotid artery plaques (r=0.46

P0.05; r=0.52

P0.01). Conclusion Hcy may be an independent risk factor for cardiovascular disease. HD+HDF and HD+CRRT can clear Hcy effectively and improve the survival rate of MHD patients.

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