维持性血液透析患者透析相关性淀粉样变的相关危险因素分析  

Risk factors of dialysis-related amyloidosis in maintenance hemodialysis patients

作　　者：王晓光[1] 陈宏[1] 郑剑琴[1] 石凌波[2] 付俊峰[3] 

机构地区：[1]广州中医药大学祈福医院肾病科,广州511495 [2]广州中医药大学祈福医院检验科,广州511495 [3]广州中医药大学祈福医院影像科,广州511495

出　　处：《临床肾脏病杂志》2015年第5期264-267,共4页Journal Of Clinical Nephrology

基　　金：广东省番禺区科学基金资助课题(NO.2012-Z-92-1)

摘　　要：目的分析维持性血液透析患者晚期糖基化终产物、自由基代谢与透析相关性淀粉样变（dialysis-related amyloidosis，DRA）的相关性。方法将46例肩关节B超检查有DRA的患者按透析时间分为短期透析组（16例）和长期透析组（30例），另选择10名健康志愿者为对照组。观察所有患者血清晚期糖基化终产物（the advanced glycation end prodvcts，AGE）及生物学指标Nε-羧甲基赖氨酸（Nε-carboxymethyllysin，CML）的变化，自由基代谢相关的超氧化物歧化酶（superoxide dismutas，SOD）、脂质过氧化物（peroxidativelipi，LPO）值的变化，与β2-微球蛋白（β2-microglobulin，β2-MG）、C反应蛋白（C-reactive protein，CRP）的相关性。结果DRA患者AGE、CML、LPO、β2-MG、CRP水平较正常对照组明显提高，SOD水平明显降低，差异有统计学意义（P〈0．05或P〈0．01）。随着透析龄的延长，肩袖周围增强回声阳性率明显增加，DRA病变程度加重。长期透析组与短期透析组比较，AGE、CML、LPO、β2-MG、CRP升高的水平和SOD水平降低幅度明显增大，2组相比有统计学差异（P〈0．05）。透析龄与肩关节淀粉样变程度正相关，与AGE、CML、LPO、β2-MG、CRP水平呈正相关（P〈0．05），与SOD水平呈负相关（P〈0．05）。提示维持性血液透析患者AGE、β2-MG、CML水平增高可能是DRA形成早期病变的物质基础，氧化应激反应增强、慢性炎症反应增强可能参与DRA早期形成过程。结论预防DRA或延缓其发展应从降低循环β2-MG水平和抑制关节炎症入手，抑制β2-MG的AGE修饰，清除AGE修饰蛋白或阻断AGE-β2-MG与细胞表面AGE受体的相互作用，可能是预防或延缓DRA发展的途径。Objective To analyze the correlation between advanced glyeosylation end products （AGE）, free radical metabolism and dialysis-related amyloidosis （DRA） in the maintenance hemodialysis patients. Methods Serum AGE and Ne-carboxymethyllysine （CML） in 46 cases of DRA diagnosed by shoulder B-ultrasound were tested. Superoxide dismutase （SOD）, lipid peroxide （LPO）, β2-microglobulin （β2-MG） and C-reactive protein （CRP） were detected. Results In DRA patients, AGE, CML, LPO, β2-MG and CRP levels were significantly increased, and SOD levels were significantly reduced as compared with control group （P〈0. 05 or P〈0. 01）. With the prolonged duration of dialysis, EP-positive rate was significantly increased, and DRA aggravated. The AGE, CML, LPO, β2-MG and CRP levels were increased, and SOD levels reduced more significantly in the longterm dialysis group than the short-term dialysis group （P〈0. 05）. Dialysis age was positively correlated with shoulder amyloidosis degree and levels of AGE, CML, LPO, β2-MG and CRP, but negatively with SOD levels （P〈0. 05 for all）. The increases of AGE, β2--MG and CRP in maintenance hemodialysis may be the material basis of DRA early lesions. The enhanced oxidative stress and chronic inflammation may be involved in the formation process of the early DRA. Conclusions Preventing or delaying the development of DRA should reduce the circulating β2-MG levels and inhibit the joint inflammation. Inhibiting the AGE decoration of β2-MC, clearing AGE decorative protein or blocking the interaction between AGE-β2-MG and cell surface receptor may be the way to prevent DRA or delay the development of DRA.

关 键 词：维持性血液透析 淀粉样变 晚期糖基化终产物 自由基代谢 

分 类 号：R459.5[医药卫生—治疗学]