尿毒症患者血液透析前后血清sCD40、sCD40L和CRP水平的变化及意义  

Change of serum levels of sCD40,sCD40L and CRP before and after hemodialysis and its significance in patients with uremia

作　　者：张健[1] 倪强[1] 

机构地区：[1]昆山市第一人民医院检验科,江苏昆山215300

出　　处：《临床和实验医学杂志》2011年第24期1910-1912,共3页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨尿毒症患者血液透析(HD)前后血清中可溶性CD40(sCD40)、可溶性CD40配体(sCD40L)和C反应蛋白(CRP)的变化规律及其在肾损伤中的可能作用。方法采用酶联免疫吸附试验(ELISA法)测定sCD40和sCD40L,免疫比浊法测定C反应蛋白(CRP)检测50例健康人(对照组)、100例维持性血液透析患者(HD组)血液透析前、后血清sCD40、sCD40L、CRP和血清肌酐(SCr)的水平。结果 HD组血清sCD40、sCD40L、CRP和SCr水平明显高于对照组(P<0.01),HD伴冠心病组sCD40、sCD40L和CRP水平与不伴冠心病组比较差异亦有统计学意义(P<0.01);血液透析后血清CRP水平较透析前显著升高(P<0.01),sCD40L和SCr水平明显下降(P<0.01);相关分析显示,尿毒症血透患者血清中sCD40、sCD40L、CRP和SCr之间呈正相关关系(r=0.668,r=0.549,r=0.721,均P<0.01)。结论血液透析患者存在微炎症状态,sCD40、sCD40L和CRP协同发挥微炎症及细胞毒效应,共同参与了尿毒症患者肾脏损伤的病理过程,亦可能参与了动脉粥样硬化的形成,可作为间接判断血液透析患者预后的预测指标。Objective Our aim was to investigate the change of serum levels of sCD40,sCD40L,and C-reactive protein（CRP） before and after hemodialysis and its influence on the state of inflammation in patients with uremia.Methods Serum concentrations of sCD40,sCD40L and CRP were measured in 100 uremia patients before and after a single hemodialysis and 50 healthy subjects.sCD40 and sCD40L were quantified by ELISA,and CRP by immunoturbidimetry.Results Hemodialysis patients showed significantly higher serum concentrations of sCD40,sCD40L,CRP and SCr than healthy subjects（P0.01）.CPR level after hemodialysis was significantly increased than that before hemodialysis（P0.01）,whereas sCD40 and sCD40L levels were remarkably decreased after hemodialysis（P0.01）.Concentrations of sCD40,sCD40L and CRP were lower in uremia patients without coronary artery disease than uremia patients with coronary artery disease after hemodialysis（P0.01）.sCD40,sCD40L and CRP levels in hemodialysis patients were positively correlated with SCr concentrations（r=0.668,P0.01;r=0.549,P0.01;r=0.721,P0.01 respectively）.Conclusion The hemodialysis patients are generally in the state of micro-inflammation.As markers of inflammation,sCD40,sCD40L and CRP may act synergistically to participate the pathogenesis and development of kidney injury and increase cardiovascular morbidity.They may have potentially important clinical value in allowing possibly ongoing surveillance of high-risk patients.

关 键 词：尿毒症 血液透析 sCD40 SCD40L CRP 

分 类 号：R692.5[医药卫生—泌尿科学]