慢性肾脏病患者血清淀粉样蛋白A水平与心血管疾病的关系  

Relationship between serum amyloid A level and cardiovascular disease in chronic kidney disease patients

作　　者：邬碧波[1] 张黎明[1] 梅长林 唐琦[1] 洪鹰[1] 俞勇[1] 

机构地区：[1]第二军医大学长征医院闸北分院肾内科,上海200070 [2]长征医院肾内科 解放军肾脏病研究所

出　　处：《中华肾脏病杂志》2007年第12期767-772,共6页Chinese Journal of Nephrology

基　　金：上海市卫生局科技发展基金（054122）;上海市闸北区卫生局科研基金（2005重点学科01）

摘　　要：目的研究慢性肾脏病（CKD）患者血清淀粉样蛋白A（SAA）水平的变化及其与心血管疾病的关系。方法对178例CKD患者（非透析治疗120例,血液透析58例）的临床及实验室资料作回顾性研究。应用ELISA法检测SAA水平。分析SAA的变化与其他相关因素,特别是与心血管疾病的关系。结果CKD患者无论透析与否,SAA水平均较对照组显著升高（P〈0.05）,而血液透析（CKD5期）患者SAA水平较其他各期CKD患者更高（P〈0.05）。直线相关分析显示CKD患者SAA水平与超声心动图异常、心血管疾病的发生、尿蛋白量（24 h）、透析龄、血总胆固醇（Tch）、脂蛋白（a）[Lp（a）]、C反应蛋白（CRP）、白介素1β（IL-1β）、IL-6及肿瘤坏死因子α（TNF-α）等呈正相关;而与肾小球滤过率（GFR）、血清白蛋白（Alb）、高密度脂蛋白胆固醇（HDL-C）和载脂蛋白（apo）A呈负相关。多因素逐步回归分析显示SAA与CRP是心血管疾病的独立危险因素。结论CKD患者SAA水平升高可能与生成增加和排出减少有关。SAA是CKD患者并发心血管疾病的危险因素之一。Objective To detect the level of serum amyloid A （SAA） and explore its relationship with cardiovascular disease （CVD） in patients with chronic kidney disease （CKD）. Methods Clinical data of 178 CKD patients, including 120 non-dialytic （ND）, 58 hemodialysis （HD）, and 60 controls were collected and analyzed retrospectively. SAA level was detected by enzyme-linked immunosorbent assay （ELISA）. Left ventricular diameter （LVD）, left atrial diameter （LAD）, left ventricular posterior wall thickness（LVPWT）, interventricular septal thickness （IVST） and left ventricular ejection fraction （LVEF） were detected by ultrasonic cardiography. Relationship between SAA level and CVD incidence in CKD patients was analyzed by Logistic regression model. Results The average level of SAA in CKD patients was significantly higher than that in control group （P〈0.05）, and was significantly higher in HD group as compared with ND group （P〈0.05）. SAA level increased with the progression of renal dysfunction. In ND group, SAA level was negatively correlated with glomerular filtration rate （GFR） and positively correlated with the proteinuria respectively （P〈0.05）, while in HD group, it was positively correlated with dialysis duration （P〈0.05）. However, in both groups, SAA level was positively correlated with C-reactive protein（CRP）, interleukin 1β（IL-1β）, interleukin 6 （IL-6）, tumor necrosis factor-α （TNF-α, Tch and Lp（a） respectively（P〈0.05）. A positive correlation of SAA level with the clinical manifestations such as abnormal echocardiography and cardiovascular disease was found. A negative correlation was also found between SAA level and serum albumin, HDL-C and apoA （P 〈0.05）. Conclusions SAA level elevates markedly in CKD patients which may result from increased synthesis and decreased excretion. SAA may be an isolated risk factor of CVD in CKD patients.

关 键 词：肾功能衰竭 慢性 心血管疾病 血清淀粉样蛋白A 

分 类 号：R686[医药卫生—骨科学]