慢性肾脏病患者C-反应蛋白、24小时尿蛋白水平和颈动脉内中膜厚度测定的意义  

Significance of C-reactive protein,twenty-four-hour urine protein and carotid artery intima-media thickness detection in patients with chronic kidney disease

作　　者：刘江[1] 杨金国[1] 杨敏[1] 张豪杰[1] 裘晓蕙[1] 

机构地区：[1]宁波市医疗中心李惠利医院肾内科,浙江宁波315040

出　　处：《全科医学临床与教育》2010年第1期12-15,共4页Clinical Education of General Practice

摘　　要：目的探讨慢性肾脏病(CKD3期、CKD4期、CKD5期)患者C-反应蛋白(CRP)、24h尿蛋白水平与颈动脉内中膜厚度(IMT)的关系。方法选择慢性肾脏病3～5期患者50例和10例健康对照者,用高分辨率B超测IMT,测CRP和24h尿蛋白水平。结果CKD3期组、CKD4期组、CKD5期组CRP与对照组比较,差异有统计学意义(t分别=11.42、11.56、27.19,P均<0.05);CKD3期组、CKD4期组、CKD5期组24h尿蛋白与对照组比较,差异有统计学意义(t分别=4.25、1.98、2.94,P均<0.05);CKD3期组、CKD4期组、CKD5期组IMT与对照组比较,差异有统计学意义(t分别=4.02、9.97、13.02,P均<0.05);不同IMT的CKD患者CRP、24h尿蛋白、肌酐清除率比较,差异有统计学意义(t分别=6.94、4.05、4.61,P均<0.05);冠心病发生率CKD3期组与CKD4期组比较,CKD3期组与CKD5期组比较,差异有统计学意义(χ2分别=5.77、9.02,P均<0.05)。冠心病患者CRP、24h尿蛋白与IMT呈正相关(r分别=0.31、0.22,P<0.05),肌酐清除率与IMT呈负相关(r=-0.21,P<0.05)。脑血管意外患者CRP、24h尿蛋白与IMT呈正相关(r分别=0.35、0.26,P<0.05),肌酐清除率与IMT呈负相关(r=-0.21,P<0.05)。冠心病的发病率与CKD分期有关,脑血管意外发病率与CKD分期无关。结论CKD3期、CKD4期、CKD5期患者IMT≥0.85mm,CRP>8mg/L,应评估其心血管疾病危险因素。Objective To investigate the significance of C-reactive protein （CRP）, twenty-four-hour urine protein and carotid artery intima-media thickness （IMT） in patients with chronic kidney disease （CKD）. Methods Fifty patients with chronic kidney disease at stage 3 to 5 and 10 healthy controls were selected. IMT was determined with non-invasive high-resolution B-mode uhrasonography. Levels of plasma C-reactive protein and twenty-four-hour urine protein were determined. Results High levels of CRP, twenty-four-hour urine protein and IMT were found in CKD stage 3, 4 and 5 as compared with those in controls（t=ll.42,11.56, 27.19,4.25, 1.98, 2.94,4.02, 9.97,13.02,P〈 0.05）. Patients with different IMT in CKD had different twenty-four-hour urine protein and creatinine clearance rate （t=6.94,4.05,4.61 ,P〈0.05）.The differences of coronary artery disease incidence in CKD stage 3 as compared with CKD stage 4, CKD stage 3 as compared with CKD stage 5 were statistical （X2=5.77, 9.02,P〈0.05）. High CRP levels and twenty-four-hour urine protein in patients with coronary artery disease and brain vascular accident were strongly associated with IMT （I=-0.31,0.22;0.35,0.26; P〈0.05）,while negatively with creatinine clearance rate （r=-0.21 ,-0.21,P〈0.05） . The incidence of coronary artery disease were associated with CKI） stage, while brain vascular accident was not. Conclusions High levels of IMT （IMT≥0.85 mm） and CRP（ CRP〉8 mg/L ）are the risk factors for cerebrocardiovascular disease in CKD stage 3,4 and 5.

关 键 词：慢性肾脏病 C-反应蛋白 24小时尿蛋白 颈动脉内中膜厚度 

分 类 号：R692[医药卫生—泌尿科学]