单核细胞活化与终末期肾病炎症反应状态的关系  

Inflammatory status in patients with end-stage renal disease:role of monocyte activation

作　　者：梁敏[1] 王力[1] 侯凡凡[1] 刘俊[1] 刘志强[1] 田建伟[1] 

机构地区：[1]第一军医大学南方医院肾内科,广东广州510515

出　　处：《第一军医大学学报》2003年第8期781-784,共4页Journal of First Military Medical University

基　　金：国家自然科学基金(30100082);广东省自然科学基金(001087);全军医药卫生科研基金(012079)~~

摘　　要：目的研究终末期肾病(ESRD)炎症反应状态及其与单核细胞活化之间的关系。方法166例ESRD病人分为慢性肾功能不全非透析组(CRF,n=63)、持续性不卧床腹膜透析组(CAPD,n=16)和血液透析组(HD,n=87);测定各组以及血液透析前后血浆单核细胞活化指标,包括新喋呤、肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β),以及血浆急性时相蛋白(APP)水平,包括C反应蛋白(CRP)和血清淀粉样A物质(SAA)。结果3组ESRD病人血浆单核细胞活化指标及APP水平均比正常对照组升高(P均<0.05),HD组血浆CRP和SAA含量高于CRF组(P均<0.05),且SAA水平高于CAPD组(P<0.05);CRF组血浆TNFα、IL-1β、新喋呤以及CRP和SAA含量与血清肌酐水平呈正相关(P<0.05),与肌酐清除率(Ccr)呈负相关(P均<0.05);在以Ccr矫正后进行相关分析,血浆CRP含量与新喋呤、TNF-α和IL-1β浓度呈正相关(r值分别为0.287、0.314、0.262,P<0.05),血浆SAA含量与新喋呤浓度呈正相关(r=0.306,P<0.05);糖尿病与非糖尿病患者相比上述指标均无显著性差异(P>0.05);单次透析后血浆TNFα、IL-1β以及CRP和SAA含量比透析前显著升高(P<0.05),新喋呤浓度无显著性变化(P>0.05)。结论ESRD时存在以APP升高为特点的慢性炎症反应,血液透析具有进一步的促进作用,这种异常宿主反应可能与单核细?Objective To study the association of monocyte activation and the inflammatory status in patients with end-stage renal disease (ESRD). Methods A total of 166 ESRD patients were recruited in the study, including 63 patients with pre-dialysis chronic renal failure (CRF), 16 undergoing continuous ambulatory peritoneal dialysis (CAPD) and 87 stable hemodialysis (HD) patients. Monocyte activation markers including plasma neopterin, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and plasma levels of acute phase proteins (APP) such as C-reactive protein (CRP) and serum amyloid A (SAA) were monitored using enzyme-linked immunosorbent assay (ELISA) kits. Results The levels of neopterin, TNF-α, IL-1β, CRP and SAA significantly increased in ESRD patients as compared with the normal controls (P<0.05 ). CRP and SAA in HD patients were higher than those in non-dialysis patients (P<0.05). The levels of CRP was closely correlated with neopterin, TNF-αand IL-1β(r=0.287, 0.314, 0.262, P<0.05, respectively), and SAA with neopterin (r=0.306, P<0.05). These correlations remained significant after the values were adjusted for creatinine clearance in non-dialysis patients. Plasma contents of TNF-α, IL-1β, CRP and SAA were significantly elevated after a single hemodialysis session (P<0.05). Conclusion Chronic inflammation occurs in patients with ESRD, which might be aggravated by hemodialysis. Activation of the monocytes might be involved in the pathogenesis of inflammation in uremia.

关 键 词：终末期肾病 透析 炎症 单核细胞 

分 类 号：R692.5[医药卫生—泌尿科学]