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Objective To investigate the cardiac structural and functional characteristics in the patients with heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM),and predict the factors influencing the characteristics. Methods A total of 783 HFpEF patients diagnosed in the Department of Geriatric Cardiology,the First Hospital of Lanzhou University from April 2009 to December 2020 were enrolled in this study.Echocardiography and tissue Doppler technique were employed to evaluate cardiac structure and function.According to the occurrence of T2DM,the patients were assigned into a HFpEF+T2DM group (n=332) and a HFpEF group (n=451).Propensity score matching (PSM)(in a 1∶1 ratio) was adopted to minimize confounding effect.According to urinary albumin excretion rate (UAER),the HFpEF+T2DM group was further divided into three subgroups with UAER<20 μg/min,of 20-200 μg/min,and>200 μg/min,respectively.The comorbidities,symptoms and signs,and cardiac structure and function were compared among the groups to clarify the features of diabetes related HFpEF.Multivariate linear regression was conducted to probe the relationship of systolic blood pressure,blood glucose,glycosylated hemoglobin,and UARE with cardiac structural and functional impairment. Results The HFpEF+T2DM group had higher prevalence of hypertension (P=0.001) and coronary heart disease (P=0.036),younger age (P=0.020),and larger body mass index (P=0.005) than the HFpEF group,with the median diabetic course of 10 (3,17) years.After PSM,the prevalence of hypertension and coronary heart disease,body mass index,and age had no significant differences between the two groups(all P>0.05).In addition,the HFpEF+T2DM group had higher interventricular septal thickness (P=0.015),left ventricular posterior wall thickness (P=0.040),and left ventricular mass (P=0.012) and lower early diastole velocity of mitral annular septum (P=0.030) and lateral wall (P=0.011) than the HFpEF group.Compared with the HFpEF group,the HFpEF+T2DM group showed increased ratio of early diastolic mitral filling velocity to early diastolic mitral annular velocity (E/e') (P=0.036).Glycosylated hemoglobin was correlated with left ventricular mass (P=0.011),and the natural logarithm of UAER with interventricular septal thickness (P=0.004),left ventricular posterior wall thickness (P=0.006),left ventricular mass (P<0.001),and E/e' ratio (P=0.049). Conclusion The patients with both T2DM and HFpEF have thicker left ventricular wall,larger left ventricular mass,more advanced left ventricular remodeling,severer impaired left ventricular diastolic function,and higher left ventricular filling pressure than the HFpEF patients without T2DM.Elevated blood glucose and diabetic microvascular diseases might play a role in the development of the detrimental structural and functional changes of the heart.
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Humans , Aged , Heart Failure/diagnosis , Diabetes Mellitus, Type 2 , Stroke Volume , Glycated Hemoglobin , Blood Glucose , Propensity Score , Ventricular Function, Left , HypertensionABSTRACT
【Objective】 To explore the effect of B lymphocytes on cardiac structure and function and myocardial immune cells during heart development. 【Methods】 Echocardiography, immunofluorescence staining and flow cytometry were used to evaluate the composition of immune cells of the heart and the cardiac structure and function in wild-type (WT) mice and B-lymphocyte-deficient (μMT) mice, respectively. 【Results】 Compared with those of μMT mice, the ratio of heart weight to mouse weight (P<0.05), left ventricular mass (P<0.05) and the cross-sectional area of myocardial cells WT mice were significantly increased, while the ventricular ejection fraction was significantly decreased (P<0.05). The results of mRNA sequencing showed that WT mice and μMT mice differentially expressed genes were mainly enriched in the signal pathway of heart development and hypertrophic cardiomyopathy. The results of flow cytometry showed that WT mice had more Ly6g+ neutrophils, CD4+ positive T cells (P<0.001) and CD8+T cells (P<0.05) compared with μMT mice. 【Conclusion】 B-lymphocyte depletion alters the composition of cardiomyocyte immune cells, reduces left ventricular mass, and increases myocardial contractility.
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Objective:To evaluate the pathological features of a heart failure with preserved ejection fraction(HFpEF) model, which is established by spontaneously hypertensive rats (SHR) through high-fat diet and diabetic factors.Methods:Twenty specific pathogen-free grade(SPF grade) and 14-week-old SHR rats were randomly divided into SHR group (normal diet) and HFpEF group [high-fat diet combined with intraperitoneal injection of streptozotocin (STZ, 25 mg/kg) were used to create a diabetic complex model] with 10 rats in each group. Ten SPF and 14-week-old WKY rats with the same genetic background were set as blank control group (WKY group). All rats were fed for 8 weeks. Echocardiography was performed to measure cardiac parameters: peak velocity of early diastolic mitral inflow(E), peak velocity of late diastolic mitral inflow(A), and the early diastolic mitral annulus e′ in the same cardiac cycle, left atrial ejection fraction (LAEF), left ventricular ejection fraction (LVEF), left atrial diameter, right atrial diameter and interventricular septal thickness(IVST). Serological testing included glucose (GLU) and glycosylated serum protein (GSP); Enzyme-linked immunoassay (ELISA) testing included insulin (INS), glucagon (PG), C-peptide (CP), leptin (LEP), atrial natriuretic peptide (ANP) and B-type brain natriuretic peptide (BNP). The rat heart tissue was stained with HE, and the morphological changes of atrial/ventricular tissue were observed under an optical microscope.Results:The pathological characteristics of HFpEF was established in SHR rats fed with high fat and diabetes. Echocardiography showed that compared with the WKY group, the values of E, E/A and E/e′ in the HFpEF group were significantly increased (all P<0.01), and e′and LAEF were significantly reduced (all P<0.01). In the HFpEF group, the anteroposterior and tranverse dimensions of the left atrium and the long-axis dimension of the right atrium increased to varying degrees (all P<0.05), and the IVST was also significantly increased ( P<0.01). At the same time, atrial wall was thickened obviously, myocardial cells were disordered, and myocardial fibers were broken. Compared with the WKY group, the levels of serum markers ANP and BNP in HFpEF group were significantly increased (all P<0.01), and the levels of serum insulin-related indicators INS, PG, CP, LEP, GSP, and GLU increased to varying degrees (all P<0.01). Conclusions:The composite model established by SHR rats through high-fat diet and diabetic factors can simulate the Doppler echocardiographic changes and pathological features of HFpEF, as well as abnormal changes in serum related markers and insulin indicators.
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OBJECTIVE: To compare the echocardiography parameters during different pregnancy trimesters and to determine the reference range of echocardiography for pregnant women.METHODS: Normal pregnant women were recruited from Renji Hospital,Shanghai Jiao Tong University School of Medicine from February 2017 to December 2017.Women were randomly assigned into 4 groups,cardiac ultrasonography was performed in any one of the three trimesters or 42 days postpartum,and the reference ranges of indicators were determined in each group.Non-pregnant women of childbearing age were recruited as controls.Make a comparison of the measurement values of echocardiography at different trimesters of pregnancy.RESULTS: A total of 733 normal pregnant and non-pregnant women were enrolled,and reference values of echocardiography indexes were determined.The reference range of echocardiograph parameters for pregnant women was established for the first time.Compared with non-pregnant women,there were significant differences in echocardiography parameters among these groups. With the increase of gestational age,the radial lines of left and right atria and ventricles enlarged;the aortic root diameter and pulmonary artery diameter increased,and left and right heart systolic function declined. Most of the above changes reached a peak in the third trimester and did not return to the nonpregnancy level at 42 days postpartum. The diastolic function did not change significantly throughout pregnancy or 42 days postpartum.CONCLUSION: The current normal reference range of echocardiography is not fully applicable to pregnant women,so it is of great importance to establish a normal reference range of echocardiography for pregnant women.
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OBJECTIVE@#To evaluate the effect of tai chi exercise on cardiac and static lung function for older community-dwelling adults at risk of ischemic stroke.@*METHODS@#A total of 170 older community-dwelling adults (aged 55-75 years old) at risk of ischemic stroke were allocated to either tai chi training group (85 cases, five 60-min sessions of tai chi training per week for 12 weeks) or control group (85 cases, usual pbysical activity for 12 weeks) using a computer-generated randomization. The echocardiographic parameters of cardiac structure, cardiac function and static lung function were measured at baseline, after 12 weeks of intervention and additional 12-week follow-up period by a blinded professional staffmember using a color Doppler ultrasound imaging device or a cardiopulmonary function instrument. The t test and linear mixed model based on the intentionto-treat analysis principle was used to calculate the effect. The adverse effect was observed.@*RESULTS@#Most of echocardiographic parameters on the cardiac structure, cardiac function and static lung function between the tai chi group and control group did not have a significant difference either post 12-week intervention or additional 12-week follow-up period. Only three parameters involving in right ventricular diameter (P=0.024), main pulmonary artery diameter (P=0.002) and vital capacity maximum (P=0.036) were beneficial to be improved in the tai chi group compared to the control group by the analysis of mixed linear model. No adverse effects were found during the intervention period.@*CONCLUSION@#The 12-week tai chi exercise did not have an obvious beneficial effect on cardiac structure, cardiac function and static lung function in older community-dwelling adults at risk of ischemic stroke. The study with a longer duration of intervention should be necessary. (Trial registration No. ChiCTR-TRC-13003601).
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Objective To study the effect of metoprolol combined with benazepril on cardiac structure and heart function in patients with heart failure and the treatment of hypertension in the elderly. Methods 120 cases of elderly hypertensive patients with heart failure from June 2011 to June 2015 were studied, according to the random number table method, they were randomly divided into combination group and control group.The two groups were given symptomatic and supportive therapy, the control group on the basis of conventional treatment were given antihypertensive drugs of benazepril; combination treatment group were given metoprolol on the basis of control group. After treatment, the clinical efficacy of the two groups were evaluated, the changes of cardiac structure in the two groups were recorded and analyzed before and after treatment, and the blood pressure and cardiac function were analyzed. Results The total effective rate of the combined group was 91.67%, the control group was 78.33%, there was significant difference between the two groups (χ2=4.1830, P=0.0408). After 6 months of treatment, the blood pressure, cardiac structure and 6min walking distance were significantly improved in the two groups (P<0.05). The above indicators in combination group were significantly better than those in the control group (P<0.05). The complication rate in combination group was 8.33%, 13.33% in the control group, there was no statistically significant between two groups (χ2=0.7764, P=0.3782). Conclusion Metoprolol combined with antihypertensive treatment can significantly improve the clinical efficacy of the treatment, improve the cardiac structure and function.
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Objective To compare the clinical efficacy of ticagrelor versus clopidogrel on the vessels without percutaneous coronary intervention(PCI),the cardiac structure and cardiac function in patients with acute coronary syndrome(ACS).Methods The clinical data of 95 patients with ACS who received PCI in southwest hospital from January 2014 to December 2016 were analyzed retrospectively,who were divided into two groups,47 patients in the treatment group with ticagrelor and 48 patients in the treatment group with clopidogrel.The average follow-up results of vessels without PCI,the changes of cardiac structure,cardiac function between two groups were compared.Results The follow-up results at 1 years after PCI showed that the revascularization rate 6.4％ of the vascular without PCI in ticagrelor group was significantly lower than 12.5％ of clopidogrel group(P ＜ 0.000 1);vascular disease progression and recurrence rate of angina in ticagrelor group was significantly lower than those of clopidogrel group;the LEVF and LVEDD of ticagrelor group improved better,and level of BNP was significantly decreased.There was no significant difference in risk of hemorrhage between two groups,but the incidence of dyspnea in ticagrelor group was higher than that of clopidogrel group.Conclusion Ticagrelor is superior to clopidogrel in the protection of vessels without PCI,and be helpful to improve the cardiac structure and cardiac function in patients with acute coronary syndrome(ACS) after PCI.
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Background: Hypothyroidism is a clinical syndrome resulting from a deficiency of thyroid hormones, which in turn results in a generalized slowing down of metabolic processes. Hypothyroidism affects 2% of adult women and 0.1-0.2% of adult men. Thyroid hormones exert direct cellular effects on almost all tissues of the body. It causes multi-organ dysfunction due to deranged metabolism. Objectives: To study Electrocardiographic and echocardiographic evaluation of heart in newly diagnosed hypothyroid patients. Methods: This study was a conducted as a prospective study carried out from January 2012 to July 2013 at Mediciti Institute of Medical Sciences. The criteria for diagnosis of hypothyroidism was Clinical assessment, Thyroid hormone assay–TSH - >5 μIU/ml, FT4 - < 0.7 ng/dl, FT3 - < 2.4 pg/dl. Investigations like Complete Blood Picture, Complete Urine Examination, Random Blood Sugar, Blood urea, Serum Creatinine, Fasting lipid profile, Chest X Ray, Standard 12 Lead ECG were done. Results: On systemic examination, Cardiomegaly and diminished heart sound was found in 13.3% and 9.99% patients. Normal ECG is found in 36.66% of patients before treatment and 66.66 % after treatment. Bradycardia is most common finding seen in 6 patients counting for 20%, followed by low voltage complexes and ST changes in 16.66% patients respectively before treatment. Echo findings are normal in 43.33% cases before treatment and 66.66% after treatment. Pericardial effusion and Diastolic dysfunction are the common findings seen in 8 cases each accounting to 26.66% cases, which reduced to 13.3% and 9.99% respectively after management. Systolic dysfunction was found in 9.99% of patients after treatment. Conclusion: Hypothyroid state, which has significant impact on cardiac structure/function associated with increased CVS morbidity and mortality is reversible with treatment.
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Objective To investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) could improve the left ventricular structure and function of MHD patients with resistant hypertension. Methods This study was a prospective, randomized, controlled clinical trial. 65 MHD patients with resistant hypertension of our hospital were enrolled and then randomly divided into Group HD+HP and Group HD. The follow-up study was 12 months. The major outcome measures were related to the cardiac structure and function, and the serum inflammatory factors. Results No statistical differences of related factors such as blood pressure and cardiac function was observed in HD group. The serum concentration of inflammatory factors was higher after one-year HD treatment alone. But the serum concentration of inflammatory related factors , blood pressure, cardiac function and related indexes were lower in HD + HP than in Group HD (P < 0.05);HD + HP group had higher ejection fraction (EF) and SV, which demonstrated the improved cardiac function (P < 0.05). Conclusions HD + HP was superior to HD in the treatment in alleviating cardiac after-load and improving the left ventricular structure and function of MHD patients with resistance hypertension.
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Objective To assess the cardiovascular structure and function in children with confirmed primary hypertension,and to explore the impact of hypertension and related risk factors on cardiovascular structure and function of children.Methods Parameters related to cardiac structure,vascular structure and function were measured in 213 hypertensive children,who were confirmed upon repeated measurements on separate occasions.A total of 197 healthy children were recruited as controls.Results 1) In hypertensive children,left ventricular end-diastolic diameter (LVEDd),left ventricular end-systolic diameter (LVESd),left ventricular mass (LVM),left ventricular mass index (LVMI),left ventricular posterior wall thickness (LVPT) and interventricular septal thickness (IVST) were all significantly higher than their counterparts (P＜0.05).No statistical differences were found in carotid intima-media thickness (cIMT),relative wall thickness (RWT) and brachial ankle pulse wave velocity (ba-PWV).2) Compared with controls,LVEDd,LVESd,LVM,LVMI were all significantly higher in hypertensive children (P＜0.05),regardless of age group or weight-status.No statistical differences were found in ccIMT and RWT,while ba-PWV was statistically higher in controls among children aged 6-12 years.3) Data from multiple linear regression analysis noticed that LVMI was associated with age,sex,BMI and hypertension while RWT was associated with age and BMI.Conclusion In children with primary hypertension,changes of vascular structure and function were not shown but left ventricular remodeling and early changes of function had been developed in children under 12 years old.
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Objective To compare the cardiac structure and function between diabetic and non-diabetic with different peritoneal transport type.Methods A total of 84 patients with continuous ambulatory peritoneal dialysis (CAPD) in our center for 6 months were enrolled in this study.Forty-six patients of subjects were diabetic,another 38 were non-diabetic.Patients were divided into four groups according to the results of peritoneal equilibration test (PET) and the ratio of creatinine concentration in dialysate solution and plasma (D/P creatinine concentration).Patients with D/P creatinine concentration ＞ 0.65 were with high permeability and otherwise were low permeability.The four groups were diabetic-H (high permeability) group,diabetic-L(low permeability) group,non-diabetic-H (high permeability) group,non-diabetic-L (low permeability) group.The levels of left atrial diameter (LAD),left ventricular diameter(LVD),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular ejection fraction(LVEF) were measured before and after 6-month peritoneal dialysis by ultrasonic doppler.Results Before peritoneal dialysis,there were no significant difference in the terms of all parameters among four groups(P ＞0.05).After 6 months of peritoneal dialysis,the albumin levels,IVST,LVPWT and LVEF in diabetic-L group,non-diabetic-L,diabetic-H group and non-diabetic-H group were ((36.57 ± 3.34),(37.21 ± 4.12),(34.19 ± 3.98),(34.51 ± 4.52) g/L respectively;F =9.034),((10.45 ± 1.12),(10.17 ± 1.35),(11.32 ± 1.09),(11.46 ± 1.38) mm respectively;F =7.525),((9.58 ± 1.42),(9.47 ± 1.31),(10.71 ± 1.40),(10.15 ± 1.41) mm respectively; F =4.963) and ((63.98 ± 4.73) ％,(63.92 ± 5.17) ％,(60.12 ± 5.12) ％,(61.43 ± 5.57) ％respectively ;F =6.984),and the differences were statistic significant (P ＜ 0.05).Compared to diabetic-H group and non-diabetic-H group,there were significant difference in the terms of all above indexes between diabetic-L group,non-diabetic-L (P ＜ O.05).Conclusion The peritoneal transport.type of diabetic patients is high permeability,which might be an important factor affecting cardiac complications in patients.
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Objective To study the changes of cardiac structure,heart function and pulmonary arterial pressure of the Han Chinese back to the plain after living long time on Tibetan Plateau. Methods Randomly choose 67 cases out of the Han people who have moved to the Tibetan Plateau many years , and been examined to make sure they have no disease caused by other factors. Examine their cardiac structure, heart function, pulmonary arterial pressure and valve flow velocity in Tibetan Plateau and about 60 days later back in plains respectively. Then make statistical analysis of high altitude cardiopulmonary adaptation and de-adaptation reaction according to the differences. Results Only were the values of pulmonary artery systolic pressure (PASP) and tricuspid regurgitation (TR) from the group back to plains lower than those from the group migrated to plateau (P = 0.045; P = 0.041). Other indicators of cardiac structure, heart function, pulmonary arterial pressure and valve flow velocity did not change significantly between the group back to plains and the group migrated to plateau (P > 0.05). Conclusions To Han people who returned to plains about 60 days later after long time staying on plateau , only the values of PASP and TR significantly reduce , which have not recovered to normal levels. This may be correlated with the ageing factor and long time migrating.
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Objective To investigate the changes of cardiac structure and function in type 2 diabetes mellitus (T2DM), analyze the related risk factors of heart failure, and improve the awareness of the effect of diabetes on the heart. Methods Randomly selected 170 cases of T2DM patients As the object of study, 170 cases of non diabetic patients as con-trol group, according to whether complicated with heart failure were divided into heart failure patients and non heart failure patients.Comparison of each group left ventricular posterior wall thickness, left ventricular end diastolic diameter, left ven-tricular end systolic diameter, left ventricular ejection fraction, E/A ratio Differences, analysis of the related risk factors of heart failure by logistic regressive.Results T2DM group left ventricular posterior wall thickness, left ventricular end diastolic diameter and left ventricular end systolic diameter increased , Left ventricular ejection fraction decreased, E/A ratio de-creased, were statistically significant difference compared with the control group (p <0.05).These differences are mainly come from non heart failure patients.Logistic regression showed that factors in patients with diabetes duration, HbA1c, com-pliance and complications of hypertension, coronary heart disease, is a risk factor for heart failure complicated with T2DM (all p<0.01).These may be the risk factor for diabetic patients with heart failure.Conclusion Diabetes can cause cardiac remodeling, systolic and diastolic dysfunction maybe some T2DM patients.They did not show symptoms of heart failure in the clinical, but their Cardiac structure and function are abnormal.We should pay attention to the cardiac function examination and early evaluation, prevention of risk factors, to avoid the occurrence of heart failure.
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Objective To study the relationship between urinary albumin excretion rate(UAER)and cardiac structure and function in type 2 diabetes mellitus(T2DM).Methods Five hundred and twenty patients with T2DM were divided into three groups by 8 h UAER:normoalbuminuria group(424 cases),microalbuminuria group(75 cases)and macroalbuminuria group(21 cases).At the same time,50 healthy people were selected as control group.The cardiac structure and function in four groups were evaluated by echocardiographic measurements.Results Left atrial dimensio[(34.39±3.46)mm],left ventricular posterior wall thickness[(10.34±1.05)mm],relative wall thickness(0.46±0.05),interventricular septal thickness[(10.49±1.07)mm],left ventricular mass[(167.37±32.12)g],left ventricular mass index[(87.62±12.16)g/m2]in macroalbuminuria group were significantly higher than those in control group[(32.59±2.71)mm,(9.30±0.77)mm,0.42±0.04,(9.75±0.81)mm,(147.33±27.23)g,(80.14±13.81)g/m2](P＜0.05),mean while the ratio of E/A(0.82±0.19)in macroalbuminuria group was significantly lower than that in control group(1.21±0.16)(P＜0.05).Conclusions In T2DM patients with albuminuria,the cardiac structure and function have changed.With the increase of UAER,the impairments are more prominent.And it may predict diabetes cardiomyopathy.
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Objective To investigate the correlation between the changes of left ventricle and age,duration,blood-pressure,hemoglobin,serum creatinine level and glomerular filtration rate (GFR) in lupus nephritis (LN) patients.Methods One hundred and thirty-two patients with systemic lupus erythematosus (SLE) were divided into LN group and non-LN group,the clinical data were analyzed with t test,x2 test,Pearson correlation analysis and multiple regression analysis.Results Compared with non-LN patients (4/67,6％ ),the incidence of concentric hypertrophy was significantly increased in LN patients ( 14/65,22％ ) (x2=6.790,P＜0.05 ).Left ventricular end systolic internal dimension (LVESd) was correlated positively with blood uric acid (BUA) level (B=0.014,P＜0.01 ).Left ventricular mass index (LVMI) was correlated positively with blood urea nitrogen (BUN) level (B=2.977,P＜0.01 ).lnter-ventricular septal thickness (IVST) was correlated positively with systolic blood pressure (B=0.022,P＜0.01 ).Conclusion Compared with non-LN patients,the incidence of concentric hypertrophy is significantly increased in LN patients.It may be one of the mechanisms that SLE could involve kidney,which consequently lead to hypertension,higher BUN and BUA level,which may further aggravate heart damage in turn.
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Objective To investigate the effect of allogeneic bone marrow mesenchymal stem cell transplantation on the cardiac structure and function in rats with acute myocardial infarction. Methods Thirty SD rats were randomly divided into blank group, model group, and stem cells group, 10 rats in each group. The model group received left coronary artery ligation to induce acute myocardial infarction, and the stem cells group received myocardial injection of stem cells after coronary artery ligation. After four weeks, cardiac function and heart tissue pathological changes were observed. Results In the model group, left ventricular end-diastolic volume, left ventricular end-systolic volume and end dias-tolic volume were increased, and left ventricular ejection fraction, left ventricular fractional shortening rate and cardiac output were decreased as compared with the normal group and the stem cells group (P < 0. 05). The results of pathologi-cal examination showed that myocardiac fibers dissolved or even disappeared, and fibric proliferation and sear occurred in the model group; in the stem cells group, the arrangement of myocardiae fibers was in disorder and there were a few pro-liferated fibers and scar compared with the normal group. Conclusion Allogeneic bone marrow mesenchymal stem cell transplantation can improve the cardiac structure and function in rat model of acute myocardial infarction.
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Diabetic cardiomyopathy ( DC) is an independent complication of diabetes mellitus accompanied with cardiac metabolic imbalances ( increase of fatty acids and reduction of glucose) ,which would impair cardiac function and structure seriously. Peroxisome proliferator-activated receptors ( PPARs) are ligand-activated transcription factors belonging to the nuclear hormone receptor superfamily,and they could transcriptionally regulate energy metabolism and function. PPARs also play an important role in regulating metabolism in DC heart,and directly or indirectly affect cardiac function and structure.
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Objective To determine the relationship between serum adiponectin level and cardiac structure and function in hemodialysis(HD)patients.Methods 46 MHD uremia patients and 20 healthy volunteers were included in this study.The serum adiponectin,total protein,albumin,triglyceride,cholesterol,were determined,and echocardiographic were perfomed.The association between ADPN and cardiac structure and function were analyzed respectively.Results Serum ADPN level was higher in HD patients than that in controls[(16.89?4.87)mg/L vs(7.24?2.56)mg/L,P