炎症因子对维持性血液透析患者左心室重塑的影响  

Inflammatory factors on left ventricular remodeling in patients with maintenance hemodialysis

作　　者：邬碧波[1] 唐琦[1] 张黎明[1] 贺云岚[1] 郝晓萍[1] 

机构地区：[1]上海市闸北区中心医院肾内科,上海200070

出　　处：《中国血液净化》2007年第4期180-183,共4页Chinese Journal of Blood Purification

基　　金：上海市卫生局科技发展基金项目(No.054122);上海市闸北区卫生局科研基金(2005重点学科01)

摘　　要：目的通过观察白介素-1β(IL-1β)、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)对维持性血液透析(MHD)患者心脏结构和功能相关指标的影响,探讨炎症因子对MHD患者左心室重塑的作用。方法选择上海市闸北区中心医院肾内科血液净化中心透析龄超过3个月的MHD患者64例,病情稳定,已排除急性感染及其他活动性疾病,分别检测患者的各种炎症因子、并应用心脏超声心动图测定患者的左房内径(LAD)、左心室舒张末内径(LVDd)、左心室收缩末内径(LVDs)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT),左心室射血分数(LVEF)等、计算左心室心肌重量指数(LVMI),分析MHD患者炎症因子对左心室重塑的影响。结果MHD患者血清CRP、TNF-帷L-1β、IL-6、IL-8水平均显著高于正常对照组,二者差异有显著性(P<0.05,P<0.01);MHD患者LAD、LVDd、IVST、LVPWT值均明显高于正常对照组,二者差异有显著性(P<0.05,P<0.01),LVEF值较正常对照组明显降低(P<0.05),LVMI较正常对照组显著升高(P<0.01),有统计学意义;CRP、IL-1β、IL-6、TNF-α分别与LAD、LVDd、IVST、LVPWT、LVMI呈正相关(P<0.05,P<0.01),与LVEF呈负相关(P<0.05);CRP分别与IL-1β、IL-6、TNF-α相互之间呈正相关(P<0.05,P<0.01);TNF-α、IL-1β、IL-6相互之间呈正相关(P<0.05)。结论MHD患者存在微炎症状态,并且可能参与了左心室重塑的发生和发展。Objective To investigate the effects of interleukin 1β （IL-1β）, interlenkin 6 （IL-6）, interleukin 8 （IL-8）, tumor necrosis factor- （TNF-） and C-reactive protein （CRP） on left ventricular remodeling in patients with maintenance hemodialysis. Methods Sixty-four patients with maintenance hemodialysis were selected, who had undergone hemodialysis for more than three months and were in a stable clinic status without signs of acute infections or other progressive diseases. Serum IL-1β, IL-6, IL-8 and TNF- were measured by enzyme-linked immunosorbent assay （ELISA）. The left atrial diameter （LAD）, left ventricular end-diastolic diameter （LVDd）, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT） and left ventricular ejection fraction （LVEF） were measured by ultrasonic cardiography. Results The average serum IL-1β, IL-6, IL-8, TNF-and CRP were significantly higher in patients than those in the normal control group （P 〈 0.05 or P 〈 0.01）. LAD, LVDd, IVST, LVPWT and left ventricular mass index （LVMI） increased significantly （P 〈 0.05 or P〈0.01）, while LVEF decreased markedly （P 〈 0.05）. In patients with maintenance hemodialysis, the average serum IL-1β, IL-6, TNF- and CRP were positively correlated with the values of LVDd, LAD, LVPWT, IVST and LVMI （P 〈 0.05 or P 〈0.01）, but negatively correlated with the value of LVEF （P〈 0.05）. The mean level of CRP was positively correlated with the levels of IL- 1β, IL-6 and TNF- （P 〈 0.05 or P 〈0.01）, and the mean level of TNF- was positively correlated with the levels of IL-1β and IL-6 （P 〈 0.05）. Conclusion The inflammatory factors are probably involved in the presence and progression of left ventricular remodeling in patients with maintenance hemodialysis.

关 键 词：C反应蛋白 白细胞介素 肿瘤坏死因子 心室重塑 血液透析 

分 类 号：R318.16[医药卫生—生物医学工程] R446.6[医药卫生—基础医学]