The Effect Of Peritoneal Dialysis On Plasma Hcy And Serum NO Of The Uremic Patients And The Discussion Of Prevention And Treatment Of Cardiovascular Complications

Objetcive:Homocysteine(Hcy) is a non-essential amino acid.Kidney is an important metabolism place.In the recent years,homocysteine is considered as an independent risk factor of cardiovascular disease.The plasma homocysteine level is often significantly higher in the patients of chronic renal failure.And the increased plasma Hcy level is parallelled with the renal function decline.Homocysteine is considered an independent risk factor of cardiovascular disease.Hyperhomocys-teinemia is related to the cardiovascular disease incidence and mortality of the patients of the end-stage renal disease(ESRD).Nitric oxide(NO) is an important index of the evaluation of endothelial function.It is not yet clear that NO plays a part in the occurrence and development of chronic renal failure.And the relationship between Hcy and NO is not clear in the ESRD patients.This experiment is to explore the effect of peritoneal dialysis on plasma homocysteine and nitric oxide(NO) level of uremic patients,through detecting the serum Hcy and NO levels of the the uremia group and peritoneal dialysis group.To discuss the role of peritoneal dialysis on the prevention and treatment of cardiovascular complications in the ESRD patients.Methods:The uremia patients were collected.They were divided into the uremia group and the continuous ambulatory peritoneal dialysis(CAPD) group.The each group was 30 cases.The healthy adult were 20 cases.And they were considered as the control group.The age and gender among the three groups were matched.The patients of uremia group and CAPD group had not dominant edema,peritoneal infection and other infections,and clinical situation was stable.They had not serious heart failure, gastrointestinal bleeding,active liver disease,cancer,trauma and surgery factors.The control group had been considered by the medical examination to exclude infection, hyperlipidemia,hypertension,diabetes,cardiovascular,cerebrovascular diseases and liver and kidney disease.The plasma and serum of each group were colleted.The Hcy levels of the plasma and peritoneal dialysis fluid were measured by high performance liquid chromatography analysis.The NO levels of the serum and peritoneal dialysis fluid were measured by enzyme nitrate reduction.Results:The plasma Hcy level of the control group was 8.73±1.20μmol/L.The plasma Hcy level of the uremia group was 45.10±15.65μmol/L.The plasma Hcy level of the CAPD group was 35.96±16.86μmol/L.The Hcy level of peritoneal dialysis fluid was 9.76±7.25 umol/L.After the statistical analysis,the Hcy of the uremia group and CAPD group were higher than that of the control group(P＜0.01). The Hcy of the uremia group was higher than that of the CAPD group(P＜0.05).The plasma Hcy level of the uremia group with normal blood pressure was 32.17±7.87μmol/L,but the plasma Hcy level of the uremia group with hypertension was 51.56±14.57μmol/L.The differences between the two groups were statistically significant(P＜0.01).The plasma Hcy level of the CAPD group with normal blood pressure was 23.97±7.42μmol/L,but the plasma Hey level of the CAPD group with hypertension was 41.96±17.16μmol/L.The differences between the two groups were statistically significant(P＜0.01).The serum NO level of the control group was 53.72±11.51μmol/L.The serum NO level of the uremia group was 182.78±45.32μmol/L.The serum NO level of the CAPD group was 171.60±33.55μmol/L.The NO level of peritoneal dialysis fluid was 120.29±41.80μmol/L.After the statistical analysis,The NO level of uremia and CAPD group group were higher than that of the control group(P＜0.01).The NO level of the CAPD group was lower than that of the uremia group,but comparison between the two groups was no significant difference(P＞0.05).Conclusions:Compared with the control group,the plasma Hcy levels of the uremia group and CAPD group were higher than that of the control group.But the Hey level of CAPD group was lower than that of the uremia group.The plasma Hcy level of the uremia group and CAPD group with hypertension was higher than that with normal blood pressure.The plasma Hcy level of the ESRD patients was positively correlated with age and hypertension.Compared with the control group,the serum NO levels of uremia group and CAPD group were statistically significant,and were higher than that of the control group.And the NO level of the CAPD group was lower than that of the uremia group.But the difference between the two groups was no statistical significance.Peritoneal dialysis can remove plasma homocysteine of the uremic patients,and lower the hyperhomocysteinemia of the uremia patients.Peritoneal dialysis can remove serum NO of the uremic patients,but the difference between was no statistical significance.In the recent years,some reseraches suggested that the Hcy level of the chronic renal failure patients was an independent risk factor for cardiovascular disease.The excessive NO levels of the body were damaged to tissue and cells.Hyperhomocysteinemia was prevalent in patients of the uremia and peritoneal dialysis patients.The treatment for its hyperhomocysteinemia and the higher NO levels needs further study.