持续性非卧床腹膜透析患者血清及腹透液热休克蛋白47的表达及其与微炎症的关系  

Expression of HSP47 in serum and peritoneal dialysis effluent and its relationship with micro-inflammation in patients with continuous ambulatory peritoneal dialysis

作　　者：孙筱竹 张秋萍 王函[1] 毕慧欣[1] SUN Xiaozhu;ZHANG Qiuping;WANG Han;BI Huixin(Departmentof Nephrology,Affiliated Hospital of Guilin Medical University,Guilin 541000,Guangxi,China)

机构地区：[1]桂林医学院附属医院肾内科,桂林541000

出　　处：《医学研究与战创伤救治》2023年第4期382-387,共6页Journal of Medical Research & Combat Trauma Care

基　　金：广西壮族自治区医疗卫生适宜技术研究和开发项目(S201537)。

摘　　要：目的探讨持续性非卧床腹膜透析(CAPD)患者的血清及腹膜透析流出液中热休克蛋白47(HSP47)的表达水平及其与微炎症的关系。方法回顾性分析2018年6月至2020年2月在桂林医学院附属医院门诊规律随诊的50例CAPD患者(CAPD组)、13例血液透析(HD)患者(HD组)、12例慢性肾病(CKD)5期患者(CKD组)及10例健康体检者(健康组)临床资料,其中包括一般信息及超敏C反应蛋白(hs-CRP),检测空腹静脉血及夜间留腹腹透液标本中HSP47、转化生长因子β1蛋白(TGF-β1)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)等指标并进行分析与比较。结果与健康组比较,CAPD组、HD组中血清HSP47的水平较高(P<0.05),HD组血清TNF-α的水平较高(P<0.05)。与透析≤1年患者比较,透析>1年的CAPD患者血清IL-6、腹透液IL-6及hs-CRP的水平较高(P<0.05)。CAPD患者血清HSP47与hs-CRP呈正相关(r=0.568,P<0.001),与腹透液HSP47呈正相关(r=0.584,P<0.001)。腹透液HSP47与血清中HSP47、IL-6及hs-CRP等均呈正相关(r=0.584、0.360、0.373,P<0.001、0.031、0.028)。多因素分析提示hs-CRP、腹透液HSP47是血清HSP47的独立影响因素,hs-CRP是腹透液HSP47的独立影响因素。ROC曲线分析结果显示,血清HSP47预测CAPD患者微炎症状态的AUC为0.789(95%CI:0.612~0.911),截断值为516.65 pg/mL;腹透液HSP47预测CAPD患者微炎症状态的AUC为0.704(95%CI:0.520~0.849),截断值为640.69 pg/mL。结论CAPD患者体内存在微炎症状态。HSP47可以预测CAPD患者体内的微炎症状态。Objective To investigate the expression level of heat shock protein 47(HSP47)in serum and peritoneal dialysis effluents of continuous ambulatory peritoneal dialysis(CAPD)patients and its relationship with micro-inflammation.Methods The clinical data of 50 patients with CAPD(CAPD group),13 patients with hemodialysis(HD group),12 patients with stage 5 chronic kidney disease(CKD group)and 10 healthy subjects(healthy group)who were regularly followed up in the outpatient department of the Affiliated Hospital of Guilin Medical University from June 2018 to February 2020 were retrospectively analyzed,including general information and hypersensitive C-reactive protein(hs-CRP).HSP47,transforming growth factorβ1 protein(TGF-β1),interleukin-6(IL-6),tumor necrosis factorα(TNF-α)and other indexes in fasting venous blood and overnight peritoneal dialysis effluent(PDE)samples were detected,and these indexes were analyzed and compared.Results Compared with the healthy group,the serum HSP47 level in CAPD group and HD group was higher(P<0.05),and the serum TNF-αlevel in HD group was higher(P<0.05).The levels of serum IL-6,PDE IL-6 and hs-CRP in CAPD patients with dialysis>1 year were higher than those in patients with dialysis≤1 year(P<0.05).Serum HSP47 in CAPD patients was positively correlated with hs-CRP(r=0.568,P<0.001)and PDE HSP47(r=0.584,P<0.001).There was a positive correlation between PDE HSP47 and serum HSP47,IL-6 and hs-CRP(r=0.584,0.360,0.373,P<0.001,0.031,0.028).Multi-factor analysis suggested that hs-CRP and PDE HSP47 were independent influencing factors of serum HSP47,and hs-CRP was independent influencing factors of PDE HSP47.ROC curve analysis showed that the AUC of serum HSP47 in predicting the micro-inflammatory state of CAPD patients was 0.789(95%CI:0.612-0.911),and the cutoff value was 516.65 pg/mL.The AUC of the micro-inflammatory state predicted by PDE HSP47 was 0.704(95%CI:0.520-0.849)and the cutoff value was 640.69 pg/mL.Conclusion There is micro-inflammation in CAPD patients.HSP47 can predict micro

关 键 词：持续性非卧床腹膜透析 热休克蛋白47 微炎症 

分 类 号：R692.5[医药卫生—泌尿科学]