目的研究维持性血液透析(maintenance hemodialysis,MHD)患者肺动脉高压(pulmonary hypertension,PAH)与内皮细胞功能紊乱之间的关系。方法选取维持性血液透析患者60 名，行心脏彩超检查，以肺动脉收缩压(PASP)≥35mmHg 的为肺动脉高压组(PAH 组)，PASP＜35 mmHg 的为无肺动脉高压组(无PAH 组)，分别收集2 组患者临床资料和实验室数据，在透析间期测量2 组患者血流介导的肱动脉内皮依赖性舒张功能(FMD)及人血不对称二甲基精氨酸(ADMA)浓度。结果60 例患者17 人存在PAH(28.3%)，PAH 组和无PAH 组患者透析间期体质量增加量与干体质量比值及高敏C 反应蛋白(hs-CRP)存在显著差异(P＜0.05)。经检测PAH 组和无PAH 组FMD 分别为(12.2±1.3)%和(6.9±1.2)%，ADMA 分别为(2.97±0.31)μmol/L 和(2.10±0.29)μmol/L，采用协方差分析法矫正可能和血管内皮功能相关的其他因素后，得出FMD 和ADMA 在两组之间均有显著差异(F=63.8，P＜0.001，F=16.832，P＜0.01)。二分类Logistic 回归分析显示，左心室质量分数(LVMI(B=0.037，P=0.043)和ADMA(B=9.519,P=0.006)是MHD患者并发PAH 的主要相关因素。结论MHD 合并PAH 的患者存在显著的血管内皮细胞功能紊乱，LVMI和人血ADMA是MHD 患者并发PAH的主要相关因素。
Objective To investigate the correlation between pulmonary arterial hypertension (PAH) and vascular endothelial dysfunction in maintenance hemodialysis (MHD) patients. Methods We enrolled 60 MHD patients and assigned them into 2 groups, PAH group with pulmonary artery systolic pressure (PASP) > 35 mmHg, and non-PAH group with PASP <35 mmHg. Laboratory and clinical data were collected. Flow-mediated dilatation (FMD) was measured in brachial artery, and asymmetric dimethylarginine (ADMA) was measured at the mid-interdialysis day. Results Seventeen patients (28.3%) were diagnosed as PAH. Ratio of interval dialysis weight gain and dry weight (IDWG/DW) and high sensitivity C-reactive protein (hs-CRP) were significantly higher in PAH group than in non-PAH group (P＜0.05). After excluding other factors possibly related to endothelial dysfunction by analysis of covariance, FMD was 12.2±1.3% in PAH group, significantly higher than 6.9±1.2% in non-PAH group (F=63.8, P＜0.001), and ADMA was 2.97±0.31 μmol/L in PAH group, significantly higher than 2.10±0.29 μmol/L in non-PAH group (F=16.832, P＜0.01). Logistic regression revealed that left ventricular mass index (LVMI) (B=0.037, P=0.043) and ADMA (B=9.519, P=0.006) were the major factors for PAH. Conclusions PAH was significantly correlated with vascular endothelial dysfunction in MHD patients. LVMI and ADMA were the major factors for PAH.
