Hewitson C L, Whiting M J, Barbara J A, Mangoni A A
Department of Clinical Pharmacology, Flinders University and Flinders Medical Centre, Adelaide, Australia.
J Intern Med. 2007 Nov;262(5):571-80. doi: 10.1111/j.1365-2796.2007.01848.x.
To assess the acute effects of haemodialysis (HD) on biochemical factors modulating endothelial function.
Academic medical centre.
Forty patients (age 63.5 +/- 2.2 years, mean +/- SEM) undergoing HD.
Folic acid (F), homocysteine (tHcy), asymmetric dimethylarginine (ADMA), high-sensitivity C-reactive protein (CRP) and malondialdehyde (MDA) were measured pre-HD, 1 h after commencing HD and within the last hour of HD (end-HD). Endothelium-dependent and -independent vasodilatation were measured by applanation tonometry (changes in augmentation index, AIx, postinhaled salbutamol and postsublingual nitroglycerin) in conjunction with biochemical measurements.
Marked reductions in serum F (616 +/- 73 vs. 273 +/- 30 nmol L(-1), P < 0.001), tHcy (16.3 +/- 0.7 vs. 11.2 +/- 0.5 micromol L(-1), P < 0.001) and ADMA (0.64 +/- 0.02 vs. 0.47 +/- 0.02 micromol L(-1), P < 0.001) occurred end-HD, whereas CRP and MDA levels did not significantly change. There was no significant change in endothelium-dependent vasodilatation, whereas endothelium-independent vasodilatation improved end-HD (-23.1 +/- 1.9 vs. -17.3 +/- 1.3%, P = 0.018). Regression analysis showed that both higher ADMA (P = 0.029) and lower F levels (P = 0.040) end-HD were determinants of reduced endothelium-dependent vasodilatation end-HD (R(2) = 0.23).
HD is associated with significant reductions in F, tHcy and ADMA serum concentrations. The lack of significant effects of HD on endothelium-dependent vasodilatation could be secondary to the concomitant loss of factors either enhancing (F) or impairing (ADMA) endothelial function.
评估血液透析（HD）对调节内皮功能的生化因子的急性影响。
学术医疗中心。
40例接受HD治疗的患者（年龄63.5±2.2岁，均值±标准误）。
在HD治疗前、开始HD治疗1小时后以及HD治疗最后1小时（HD结束时）测量叶酸（F）、同型半胱氨酸（tHcy）、不对称二甲基精氨酸（ADMA）、高敏C反应蛋白（CRP）和丙二醛（MDA）。通过压平式眼压测量法（吸入沙丁胺醇和舌下含服硝酸甘油后增强指数AIx的变化）结合生化测量来测定内皮依赖性和非内皮依赖性血管舒张功能。
HD结束时，血清F（616±73 vs. 273±30 nmol/L，P<0.001）、tHcy（16.3±0.7 vs. 11.2±0.5 μmol/L，P<0.001）和ADMA（0.64±0.02 vs. 0.47±0.02 μmol/L，P<0.001）显著降低，而CRP和MDA水平无显著变化。内皮依赖性血管舒张功能无显著变化，而非内皮依赖性血管舒张功能在HD结束时有所改善（-23.1±1.9 vs. -17.3±1.3%，P = 0.018）。回归分析表明，HD结束时较高的ADMA水平（P = 0.029）和较低的F水平（P = 0.040）是HD结束时内皮依赖性血管舒张功能降低的决定因素（R² = 0.23）。
HD与血清F、tHcy和ADMA浓度显著降低有关。HD对内皮依赖性血管舒张功能缺乏显著影响可能是由于同时丧失了增强（F）或损害（ADMA）内皮功能的因子所致。
