维持性血液透析(MHD)患者外周血单个核细胞NF-κB活性与心血管疾病(CVD)相关  

The relationship between NF-κB activity of peripheral blood mononuclear cell and cardiovascular disease(CVD) in patients of maintenance hemodialysis(MHD)

作　　者：徐雁[1] 邹建洲 刘中华[2] 蒋素华[2] 徐少伟[2] 沈波[2] 丁小强[2] 

机构地区：[1]上海市同济医院肾内科,上海200065 [2]复旦大学附属中山医院肾内科,上海200032

出　　处：《复旦学报（医学版）》2012年第4期353-359,共7页Fudan University Journal of Medical Sciences

基　　金：上海市重大课题(08DZ1900602);教育部国家“211工程”重点学科建设项目(三期)(211XK20)~~

摘　　要：目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者外周血单个核细胞(peripheralblood mononuclear cell,PBMC)核因子-κB(nuclear factor kappa B,NF-κB)活性与心血管疾病(cardiovasculardisease,CVD)的关系。方法选取MHD治疗3个月以上的稳定患者(n=32),以体检健康人为对照组(n=12),采用酶联免疫吸附法检测受试者PBMC的NF-κB活性及血浆五聚素3(pentraxin 3,PTX3)。用Pearson相关和线性回归分析PBMC的NF-κB活性与其他指标的相关性。用二分类Logistic回归分析PBMC的NF-κB活性与CVD的关系。用受试者工作特征(receiver operating characteristic,ROC)曲线比较PBMC的NF-κB活性、PTX3和高敏C反应蛋白(high sensitivity C-reactive protein,hsCRP)与CVD的相关性。结果 MHD患者PBMC的NF-κB活性、血浆PTX3和血清hsCRP皆显著高于对照组;单次透析后MHD患者PBMC的NF-κB活性和血浆PTX3显著升高;合并CVD患者PBMC的NF-κB活性显著高于非CVD患者。Pearson相关分析显示PBMC的NF-κB活性与白细胞计数(r=0.454,P=0.009)、血清hsCRP(r=0.590,P<0.001)、血浆PTX3(r=0.680,P<0.001)、心肌肌钙蛋白T(r=0.409,P=0.020)及颈动脉内膜中层厚度(r=0.541,P=0.011)呈显著正相关。线性回归分析显示白细胞计数(β=0.338,P=0.028)、血清hsCRP(β=0.440,P=0.005)、血浆PTX3(β=0.487,P=0.004)及颈动脉内膜中层厚度(β=0.453,P=0.032)与PBMC的NF-κB活性独立相关。Logistic回归分析显示PBMC的NF-κB活性升高是CVD的独立危险因素(OR=8.47,P=0.022)。受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析显示,PBMC的NF-κB活性与CVD的相关性高于PTX3和hsCRP,三者的ROC曲线下面积分别为0.791(95%CI:0.633～0.950,P=0.006)、0.785(95%CI:0.628～0.943,P=0.007)和0.711(95%CI:0.514～0.907,P=0.046)。结论 MHD患者PBMC的NF-κB活性显著升高;血液透析(hemodialysis,HD)过程可激活PBMC的NF-κB;MHD患者PBMC的NF-κB活性与CVD相关,可作为患者炎症和CVD危险因素的标志物。Objective To measure the nuclear factor kappa B（NF-κB） activity of peripheral blood mononuclear cell（PBMC） and to observe the relationship between NF-κB activity and cardiovascular disease（CVD） in maintenance hemodialysis（MHD） patients.Methods Blood was obtained from 32 MHD patients before and after undergoing hemodialysis and 12 age-matched healthy subjects.Nuclear extracts NF-κB activity of PBMC and plasma pentraxin3（PTX3） were measured by enzyme-linked immunosorbant assay（ELISA）.Pearson correlation and linear regression were used to assess the relationship between NF-κB activity and other laboratory parameters.Binary logistic regression was used to assess the association of NF-κB activity and CVD in MHD patients.Receiver operating characteristic（ROC） curves were used to assess the association with NF-κB activity,PTX3,high sensitive C-reactive protein（hsCRP） and CVD in MHD patients.Results NF-κB activity of PBMC,PTX3 and hsCRP were significantly higher in MHD patients compared with controls.After a single HD session NF-κB activity of PBMC and PTX3 increased acutely.Patients with CVD had higher NF-κB activity than non-CVD patients.In all MHD patients NF-κB activity correlated positively with white blood cell count（r=0.454,P=0.009）,hsCRP（r=0.590,P0.001）,PTX3（r=0.680,P0.001）,cardiac troponin T（r=0.409,P=0.020） and carotid artery intima-media thickness（r=0.541,P=0.011）.Linear regression analysis showed that white blood cell count（β=0.338,P=0.028）,hsCRP（β=0.440,P=0.005）,PTX3（β=0.487,P=0.004） and carotid artery intima-media thickness（β=0.453,P=0.032） were independently associated with NF-κB activity.High NF-κB activity was positively and independently associated with CVD（OR=8.47,P=0.022）.ROC curves analysis showed the association between NF-κB activity and CVD was more closely than PTX3 and hsCRP.The areas under the curve for NF-κB activity,PTX3 and hsCRP were 0.791（95%CI 0.633-0.950,P=0.006）,0.785（95%CI 0.628-0.943,P=0.00

关 键 词：血液透析 核因子-κB(NF-κB) 炎症 心血管疾病(CVD) 

分 类 号：R457[医药卫生—治疗学]