Relationship between serum asymmetric dimethylarginine and left ventricular structure and function in patients with end-stage renal disease treated with hemodialysis
Relationship between serum asymmetric dimethylarginine and left ventricular structure and function in patients with end-stage renal disease treated with hemodialysis
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DOI：
10.20452/pamw.1222
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发表时间：
2012-01-01
影响因子：
--
通讯作者：
Stompor, Tomasz
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文献类型：
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作者：
Napora, Maria;Graczykowska, Anetta;Stompor, Tomasz
前言不对称二甲基精氨酸（ADMA）是一种内源性内皮型一氧化氮合酶抑制剂，被认为是内皮功能障碍的效应物。在与ADMA升高相关的多种疾病中，经常提到慢性肾脏疾病。ADMA被认为与慢性尿毒症的某些心血管不良反应有关。左心室（LV）结构和功能与ADMA之间的关系已在许多论文中进行了研究，本研究的目的是分析接受血液透析（HD）治疗的终末期肾病（ESRD）患者血清ADMA（sADMA）水平与左室几何结构和功能之间的关系。（31名女性，25名男性），年龄59.0 ± 13.1岁，接受HD治疗70 ± 67个月。测定sADMA和生化指标，并进行超声心动图检查。结果患者平均sADMA水平为2.39 ± 1.0 μ mol/L，显著高于对照组（0.55 ± 0.12 μ mol/L; P < 0.01）。根据超声心动图，将患者分为以下组：正常LV几何结构（17.8%）、向心性重塑（8.9%）、向心性肥大（35.7%）、向心性肥大（37.5%）、收缩功能受损（10.7%）和舒张功能受损（71.4%）（1例患者可能属于1组或多组）。sADMA与左室壁平均厚度（r = 0.78; P < 0.05）、相对厚度（r = 0.64; P < 0.05）及左室质量指数（r = 0.65; P < 0.05）相关，但与收缩和舒张功能指标无关。sADMA是显着较高的偏心性肥大，向心性重塑，向心性肥大的患者与正常的LV几何形状的患者相比，最高的是在患者与向心性hypertrophysics.CONCLUSIONS我们的研究表明，sADMA和左室几何形状的障碍与HD治疗的ESRD患者之间的关联。
INTRODUCTION Asymmetric dimethylarginin (ADMA) is an endogenous inhibitor of endothelial nitric oxide synthase, considered an effector of endothelial dysfunction. Among multiple diseases associated with elevated ADMA, chronic renal disease is often mentioned. ADMA is thought to be related to certain adverse cardiovascular effects of chronic uremia. The association between left ventricular (LV) structure and function and ADMA has been studied in numerous papers, but only few of them addressed this issue in end-stage renal disease (ESRD).OBJECTIVES The aim of the study was to analyze associations between serum ADMA (sADMA) levels and LV geometry and function in patients with ESRD treated with hemodialysis (HD).PATIENTS AND METHODS The study group included 56 patients (31 women, 25 men) aged 59.0 +/- 13.1 years, treated with HD for 70 +/- 67 months. sADMA and biochemical parameters were measured and echocardiography was performed. sADMA levels were also measured in the control group of healthy individuals matched for age.RESULTS Mean sADMA levels in patients were 2.39 +/- 1.0 mu mol/and were significantly higher compared with controls (0.55 +/- 0.12 mu mol/l; P < 0.01). Based on echocardiography, patients were classified into the following groups: normal LV geometry (17.8%), concentric remodeling (8.9%), concentric hypertrophy (35.7%), excentric hypertrophy (37.5%), impaired systolic function (10.7%), and impaired diastolic function (71.4%) (1 patient could be in 1 or more groups). sADMA correlated with mean (r = 0.78; P < 0.05) and relative (r = 0.64; P < 0.05) LV wall thickness and with the LV mass index (r = 0.65; P < 0.05), but not with the indexes of systolic and diastolic function. sADMA was significantly higher in patients with excentric hypertrophy, concentric remodeling, and concentric hypertrophy compared with patients with normal LV geometry, and the highest was in patients with concentric hypertrophy.CONCLUSIONS Our study demonstrated an association between sADMA and disturbances in LV geometry in patients with ESRD treated with HD.