Park Jongha, Ann Soe Hee, Chung Hyun Chul, Lee Jong Soo, Kim Shin-Jae, Garg Scot, Shin Eun-Seok
Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea.
Heart Vessels. 2014 Jan;29(1):58-64. doi: 10.1007/s00380-013-0329-y. Epub 2013 Mar 27.
Hemodialysis (HD)-induced myocardial ischemia is associated with an elevated cardiac troponin T, and is common in asymptomatic patients undergoing conventional HD. Remote ischemic preconditioning (RIPC) has a protective effect against myocardial ischemia-reperfusion injury. We hypothesized that RIPC also has a protective effect on HD-induced myocardial injury. Chronic HD patients were randomized to the control group or the RIPC group. RIPC was induced by transient occlusion of blood flow to the arm with a blood-pressure cuff for 5 min, followed by 5 min of deflation. Three cycles of inflation and deflation were undertaken before every HD session for 1 month (total 12 times). The primary outcome was the change in cardiac troponin T (cTnT) level at day 28 from baseline. Demographic and baseline laboratory values were not different between the control (n = 17) and the RIPC groups (n = 17). cTnT levels tended to decrease from day 2 in the RIPC group through to 28 days, in contrast to no change in the control group. There were significant differences in the change of cTnT level at day 28 from baseline [Control, median; -0.002 ng/ml (interquartile range -0.008 to 0.018) versus RIPC, median; -0.015 ng/ml (interquartile range -0.055 to 0.004), P = 0.012]. RIPC reduced cTnT release in chronic conventional HD patients, suggesting that this simple, cheap, safe, and well-tolerated procedure has a protective effect against HD-induced ischemia.
血液透析（HD）所致的心肌缺血与心肌肌钙蛋白T升高有关，在接受常规HD的无症状患者中很常见。远程缺血预处理（RIPC）对心肌缺血-再灌注损伤具有保护作用。我们推测RIPC对HD所致的心肌损伤也有保护作用。将慢性HD患者随机分为对照组或RIPC组。通过用血压袖带暂时阻断手臂血流5分钟，然后放气5分钟来诱导RIPC。在每次HD治疗前进行3个周期的充气和放气，持续1个月（共12次）。主要结局是第28天心肌肌钙蛋白T（cTnT）水平相对于基线的变化。对照组（n = 17）和RIPC组（n = 17）的人口统计学和基线实验室值无差异。与对照组无变化相反，RIPC组从第2天到第28天cTnT水平呈下降趋势。第28天cTnT水平相对于基线的变化存在显著差异[对照组，中位数；-0.002 ng/ml（四分位间距-0.008至0.018），而RIPC组，中位数；-0.015 ng/ml（四分位间距-0.055至0.004），P = 0.012]。RIPC减少了慢性常规HD患者的cTnT释放，表明这种简单、廉价、安全且耐受性良好的程序对HD所致的缺血具有保护作用。
