Ibrahim Mohamed, Behairy Maha, El-Ashry Marwa, Mostafa Ahmad E
Internal Medicine and Nephrology Department - Ain Shams University, Egypt.
Clinical and Chemical Pathology Department - Ain Shams University, Egypt.
Egypt Heart J. 2018 Mar;70(1):27-33. doi: 10.1016/j.ehj.2017.06.003. Epub 2017 Jul 28.
Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality in patients with end stage renal disease (ESRD). Circulating endotoxins may have toxic effect on myocardial functions and are speculated as pathogens of accelerated atherosclerosis and hemodialysis (HD) patients.
We aimed to assess the possible relation between circulating endotoxin levels and left ventricular functions parameters, common carotid artery intimal media thickness (CIMT) in prevalent HD patients.
Forty stable prevalent HD patients with mean age (47.97 ± 14.42) year using regular conventional hemodialysis sessions in Ain shams university hemodialysis unit, Cairo, Egypt were randomly selected. Diabetics, congestive heart failure and those with history of myocardial infarction or coronary artery disease were excluded from the study. All patients were studied by CBC and routine chemistry, as well as hs CRP, Intact PTH, lipid profile and endotoxin level by ELISA before and after the HD session, Delta change of endotoxin (pre dialysis endotoxin-post dialysis endotoxin) was calculated, resting Doppler echocardiographic and carotid duplex.
Mean of Pre-HD session serum endotoxin level was (0.356 ± 0.090) EU/mL and the mean of post -HD endotoxin levels was (0.367 ± 0.110) EU/mL. Significant positive correlation between post dialysis endotoxin, MV E/A ratio and grades of left ventricular diastolic dysfunction (P < 0.05) and significant correlation between delta change in endotoxin and EF% (r = -0.36,P = 0.02). By stepwise linear regression analysis for determinants of MVE/A post -HD endotoxin level independently associated with MV E/A ratio (ß = 0.350, P = 0.027). We did not detect any significant correlation between CCA atherosclerosis and neither pre nor post- HD endotoxin level nor with delta change of pre and post HD endotoxin levels.
Acute increase in post dialytic circulating endotoxin level in prevalent HD patients may be associated with both left ventricular systolic and diastolic dysfunction and that attempts to reduce endotoxin level may have a positive impact on cardiovascular complications in HD Patients.
心血管疾病（CVDs）是终末期肾病（ESRD）患者发病和死亡的主要原因。循环内毒素可能对心肌功能产生毒性作用，并被推测为加速动脉粥样硬化的病原体和血液透析（HD）患者的病因。
我们旨在评估在接受HD治疗的患者中，循环内毒素水平与左心室功能参数、颈总动脉内膜中层厚度（CIMT）之间的可能关系。
在埃及开罗艾因夏姆斯大学血液透析科，随机选择40例平均年龄（47.97±14.42）岁、采用常规血液透析治疗的稳定HD患者。糖尿病患者、充血性心力衰竭患者以及有心肌梗死或冠状动脉疾病病史的患者被排除在研究之外。所有患者在HD治疗前后均接受血常规、常规生化检查，以及通过ELISA检测高敏CRP、完整甲状旁腺激素、血脂谱和内毒素水平，计算内毒素的变化量（透析前内毒素-透析后内毒素），进行静息多普勒超声心动图和颈动脉双功超声检查。
HD治疗前血清内毒素水平的平均值为（0.356±0.090）EU/mL，HD治疗后内毒素水平的平均值为（0.367±0.110）EU/mL。透析后内毒素、二尖瓣E/A比值与左心室舒张功能障碍分级之间存在显著正相关（P<0.05），内毒素变化量与射血分数（EF%）之间存在显著相关性（r=-0.36，P=0.02）。通过逐步线性回归分析，HD治疗后内毒素水平是与二尖瓣E/A比值独立相关的决定因素（β=0.350，P=0.027）。我们未检测到颈总动脉粥样硬化与HD治疗前或治疗后的内毒素水平之间，以及HD治疗前后内毒素水平的变化量之间存在任何显著相关性。
在接受HD治疗的患者中，透析后循环内毒素水平的急性升高可能与左心室收缩和舒张功能障碍均相关，降低内毒素水平的尝试可能对HD患者的心血管并发症产生积极影响。
