慢性肾脏病患者晚期氧化蛋白产物血症及其与动脉粥样硬化的关系  

Increased levels of advanced oxidation protein products are associated with atherosclerosis in chronic kidney disease

作　　者：杨小兵[1] 侯凡凡[1] 武强[1] 周华[2] 刘郑荣[1] 杨燕[2] 张训[1] 

机构地区：[1]第一军医大学南方医院肾内科中国人民解放军肾脏病研究所,广州510515 [2]第一军医大学南方医院惠侨科,广州510515

出　　处：《中华内科杂志》2005年第5期342-346,共5页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金资助项目( 30330300;30270622 );广东省自然科学基金资助项目( 013076 );广东省团队项目(10717)

摘　　要：目的　观察慢性肾脏病(CKD)患者循环中晚期氧化蛋白产物(AOPP)水平,并探讨其与动脉粥样硬化的关系。方法　断面队列研究。选109例CKD患者和71例健康对照者,用高分辨B超测颈动脉内膜中层厚度(IMT)、切面内膜中层面积及粥样斑块。测血清AOPP、丙二醛、谷胱苷肽过氧化物酶活性(GSHPx)和C 反应蛋白水平。结果　CKD患者血清AOPP水平明显高于健康对照者(P<0 01), 62例透析者血清AOPP水平明显高于47例未透析者(P<0 01);未透析者血清AOPP水平与内生肌酐清除率呈负相关(r=-0 292, P<0 05)。38例有颈动脉粥样斑块者血清AOPP水平明显高于71例无颈动脉粥样斑块者(P<0 01)。单因素相关分析和多因素逐步回归分析均显示,血清AOPP水平与颈动脉IMT、切面内膜中层面积呈正相关(r=0 332,r=0 288,P值均小于0 05;β=0 313,P<0 001;β=0 301,P<0 01)。CKD患者血清AOPP水平与丙二醛、C 反应蛋白呈正相关(r=0 300,P=0 01;r=0 255,P<0 05 ),与血清GSHPx呈负相关(r=-0 647,P<0 01 )。结论CKD患者普遍存在高AOPP血症,血清AOPP水平随肾功能减退而增高,并与CKD患者动脉粥样硬化密切相关。Objective Accumulation of advanced oxidation protein products (AOPP) has been found in patients with chronic kidney disease(CKD) The study was performed to investigate the association between serum levels of AOPP and atherosclerosis in CKD Methods 109 CKD patients were involved in this cross-sectional cohort study Carotid artery intima-medial thickness (IMT), cross-sectional calculated intima-media area (cIM area) and plaques were determined with non-invasive high-resolution B-mode ultrasonography Serum levels of AOPP, malonyldialdehyde (MDA), glutathione peroxidase (GSHPx) and C-reactive protein (CRP) were also determined Results Higher serum AOPP levels were found in patients with CKD[(64 72±19 69) μmol/L] as compared with those in healthy controls[(30 16±6 46) μmol/L, P <0 01] AOPP levels in dialysis patients [(70 02±16 51) μmol/L] were significantly higher than those in pre-dialysis patients [(51 71±15 53) μmol/L, P <0 01] AOPP levels increased with the progression of renal dysfunction and inversely correlated with creatinine clearance(Ccr)( r =-0 292, P <0 05) Patients with carotid artery plaques showed significantly higher levels of AOPP [(73 87±19 40) μmol/L] as compared with patients without carotid artery plaques[(58 41±16 09) μmol/L, P <0 01] Serum levels of AOPP were strongly associated with carotid artery IMT( r =0 332, P <0 01) and cIM area ( r = 0 288, P <0 05) By stepwise multiple regression analysis and adjusting for age, gender, blood pressure, smoking, diabetes, body mass index(BMI), hemoglobin, lipid and albumin, strong association was still present between AOPP levels and carotid artery IMT(β=0 313, P <0 001)and cIMarea(β=0 301, P <0 01) Serum levels of AOPP were correlated positively with serum MDA( r =0 300, P =0 01) and CRP levels ( r =0 255, P <0 05), while negatively with serum GSHPx( r =-0 647, P <0 01) Conclusions Serum levels of AOPP i

关 键 词：慢性肾脏病 晚期 氧化蛋白产物血症 AOPP CKD 动脉粥样硬化 C-反应蛋白 

分 类 号：R692[医药卫生—泌尿科学] R541.4[医药卫生—外科学]