持续性非卧床腹膜透析患者微炎性反应状态及其与动脉硬化和心脏功能的关系  

Microinflammatory state and its relationship with atherosclerosis and cardiac function in patients undergoing continuous ambulatory peritoneal dialysis

作　　者：陈结慧[1] 魏昕[1] 毛海萍[1] 刘庆华[1] 陈崴[1] 刘东红[2] 安欣[1] 申伟[1] 余学清[1] 

机构地区：[1]中山大学附属第一医院肾内科,广州510080 [2]中山大学附属第一医院心血管医学部,广州510080

出　　处：《中华肾脏病杂志》2008年第4期259-264,共6页Chinese Journal of Nephrology

基　　金：广东省重点实验室奖励计划（2006860202030）

摘　　要：目的研究持续性非卧床腹膜透析（CAPD）患者血清炎性反应标志物水平与动脉硬化和心脏功能的关系。方法以27例慢性肾脏病（CKD）5期非透析患者及27例健康人为对照，对我院腹膜透析中心随诊的67例CAPD患者进行微炎性反应状态的横断面调查与分析。收集相关的临床及实验室资料。ELISA法检测血清白细胞介素6（IL-6）、IL-10水平。免疫透射比浊法检测超敏C反应蛋白（hs-CRP）水平。颈动脉彩超和超声心动图分别检测颈动脉硬化和心脏功能。结果与健康对照组血清IL．6（ng／L）、IL-10（ng／L）及hs．CRP（mg／L）比较（中位数为0．698、0．277及0），CAPD患者（2．400、1．988及1．090）和CKD5期患者（1．515、1．958及1．345）均显著升高；颈动脉硬化（44．8％、33．3％比14．8％）和左心室肥厚（LVH，70．1％、81．5％比3．7％）的发生率显著增加；左心室重量指数（LMVI）和心脏功能综合指数（Tei，0．75±0．31、0．66±0．27比0．52±0．23）亦显著升高（P〈0．01）。但CAPD患者与CKD5期患者上述指标间差异无统计学意义。IL-6、SDS抑郁量表评分和脉压差是CAPD患者发生颈动脉硬化的独立危险因素。IL-6与Tei指数呈正相关；IL-10与LVMI呈负相关，与心脏射血分数（EF）呈正相关。IL-6和原发性高血压病是CAPD患者Tei指数升高的独立危险因素。结论CKD5期非透析和CAPD患者存在微炎性反应状态，且与颈动脉硬化和心脏功能异常有关。IL-6是腹膜透析患者发生颈动脉硬化和Tei指数升高的独立危险因素。Objective To investigate the microinflammatory state and its relationship with atherosclerosis and cardiac function in patients on continuous ambulatory peritoneal dialysis （CAPD）. Methods Sixty-seven CAPD patients, 27 non-dialytic stage 5 chronic kidney disease （CKD 5）patients and 27 gender and age matched healthy controls were enrolled in this cross-sectional study. Clinical data and biochemical parameters were collected. Serum interleukin-6 （IL-6）and IL-10 levels were measured by enzyme-linked immunosorbent assay （ELISA）. Highsensitivity C-reactive protein （hs-CRP） was measured by immunoturbidimetry. Prevalence of atherosclerosis was detected by carotid ultrasonography while cardiac function was detected by echocardiography. Results Serum levels of inflammatory biomarkers were elevated significantly in CAPD and CKD 5 patients as compared with healthy controls [ IL-6 （ng/L）： 2.400, 1.515 vs 0.698; IL-10（ng/L）： 1.988, 1.958 vs 0.277; hs-CRP（mg/L）： 1.090, 1.345 vs 0 ]. Left ventricular mass index （LVMI）, myocardial performance index （Tei index 0.75±0.31, 0.66±0.27 vs 0.52± 0.23）in CAPD and CKD 5 patients increased significantly. The prevalence of carotid artery atherosclerosis and left ventricular hypertrophy （LVH）in CAPD and CKD 5 patients was significantly higher than that in healthy controls. No significant difference of the ultrasonic parameters was found between CAPD and CKD 5 patients. In CAPD patients, IL-6 was positively correlated with Tel index, whereas IL-IO was negatively correlated with LVMI and was positively correlated with ejection fraction（EF）. In a multiple regression model, IL-6, self-rating depressive scale（SDS）score and pulse pressure were independent predictors of carotid artery atherosclerosis. Similarly, IL-6 and primary hypertension were independent correlates of Tei index in CAPD patients. Conclusions Microinflammatory state exists in either non-dialytic CKD 5 patients or CAPD patients and it is associated with atherosclerosis

关 键 词：腹膜透析 炎性反应 心血管疾病 动脉硬化 

分 类 号：R459.5[医药卫生—治疗学] R581.2[医药卫生—临床医学]