Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
Circ J. 2013;77(1):181-7. doi: 10.1253/circj.cj-12-0602. Epub 2012 Sep 20.
Nitric oxide (NO) is involved in hypertension and chronic kidney disease (CKD). NO synthase can metabolize L-arginine (ARG) to generate NO and L-citrulline (CIT). Two methylated ARG derivatives, asymmetric and symmetric dimethylarginine, are also involved in NO deficiency. Thus it was hypothesized that their combined ratios relate to blood pressure (BP) abnormalities in children with early CKD.
The relationship between these ARG metabolites in plasma was examined using 24-h ambulatory BP monitoring (ABPM) profile in children and adolescents with CKD stages 1-3 (n=44). Approximately 20.4% (9/44) of children with CKD stages 1-3 were diagnosed with hypertension on clinical BP measurement, and 77.3% (33/44) had BP abnormalities on ABPM, including increased BP load, nocturnal BP non-dipping, and nocturnal hypertension. Children with CKD stages 2-3 were more prevalent with abnormal BP on ABPM, and had a higher level of CIT and CIT-to-ARG ratio than those with stage 1. Furthermore, high CIT-to-ARG ratio was significantly correlated with abnormal ABPM profile, including nocturnal hypertension, increased diastolic BP load, and nocturnal BP non-dipping. Higher CIT level was significantly correlated with increased diastolic BP load and overall ABPM profile.
Plasma CIT-to-ARG ratio may serve as a useful marker of cardiovascular outcome in children with early CKD.
一氧化氮（NO）参与高血压和慢性肾脏病（CKD）的发生发展。NO 合酶可以将 L-精氨酸（ARG）代谢为 NO 和 L-瓜氨酸（CIT）。两种甲基化的 ARG 衍生物，不对称和对称二甲基精氨酸，也与 NO 缺乏有关。因此，有人假设它们的组合比值与患有早期 CKD 的儿童的血压（BP）异常有关。
使用 24 小时动态血压监测（ABPM）在 CKD 1-3 期的儿童和青少年中检查了这些 ARG 代谢物在血浆中的关系（n=44）。大约 20.4%（9/44）的 CKD 1-3 期患儿在临床 BP 测量中被诊断为高血压，77.3%（33/44）的患儿在 ABPM 中存在 BP 异常，包括 BP 负荷增加、夜间 BP 非杓型和夜间高血压。ABPM 中存在异常 BP 的 CKD 2-3 期患儿更为常见，其 CIT 和 CIT-ARG 比值高于 1 期患儿。此外，高 CIT-ARG 比值与 ABPM 异常谱显著相关，包括夜间高血压、舒张期 BP 负荷增加和夜间 BP 非杓型。较高的 CIT 水平与舒张期 BP 负荷增加和整体 ABPM 谱显著相关。
血浆 CIT-ARG 比值可能是早期 CKD 儿童心血管结局的一个有用标志物。
