腹膜透析患者心室重构及其与血基质金属蛋白酶的关系

Status of ventricular remodeling in peritoneal dialysis patients and its correlation with serum matrix metalloproteinase

目的了解持续不卧床腹膜透析(CAPD)患者心室重构情况及其与血清基质金属蛋白酶-10(MMP-10)、基质金属蛋白酶-8(MMP-8)、基质金属蛋白酶组织抑制剂-1(TIMP-1)浓度的关系。方法选取肾内科住院CAPD及临床符合诊断慢性肾脏病(CKD)患者135例,分为CKD3、CKD4、CKD5期组和CAPD组,其中CAPD组68例;多普勒心脏彩超仪测量左室舒张末内径(LVDd)、室间隔厚度(IVST)、左室后壁厚度(LVPWT),计算左室质量指数(LVMI)和左室相对厚度(RLVT);血清MMP-10,MMP-8,TIMP-1检测采用酶联免疫吸附试验。结果 CAPD组IVST值最大,与CKD3、CKD4期组比较差异有统计学意义(P<0.05),CAPD组中IVST增厚占38.23%;CAPD组LVDd值低于CKD5期患者,差异无统计学意义,较CKD3、CKD4期组显著升高,差异有统计学意义(P<0.05)。CAPD患者存在左室肥厚(LVH)及向心性肥厚均占48.53%;CAPD患者血清MMP-10,MMP-8,TIMP-1浓度明显高于CKD3、CKD4、CKD5期患者;CAPD患者中IVST增厚组MMP-10,MMP-8,TIMP-1浓度较IVST正常组均增高,仅MMP-10比较差异有统计学意义(P<0.05);CAPD患者中向心性肥厚组和无向心性肥厚组MMP-10,MMP-8,TIMP-1比较差异无统计学意义(P>0.05)。CAPD患者中LVH组MMP-10,MMP-8,TIMP-1水平高于无LVH组,但差异无统计学意义(P>0.05);Spearman直线相关分析提示IVST与MMP-10(r=0.382,P=0.010),TIMP-1(r=0.252,P=0.038)成正相关,与MMP-8无相关性,RLVT与MMP-10成正相关(r=0.243,P=0.045),LVDd、LVMI与MMP-10,MMP-8,TIMP-1间关联无统计学意义(P>0.05)。结论 CAPD患者心室重构较早期CKD患者明显;CAPD可能不能逆转尿毒症患者已经存在的心室重构;MMP-10,TIMP-1与心室重构之间具有相关性。

Objective To investigate the status of ventricular remodeling in continuous ambulatory peritoneal dialysis( CAPD) patients and its correlation with serum concentrations of matrix metalloproteinase-10( MMP-10),matrix metalloproteinase-8( MMP-8),tissue inhibitor of metalloproteinase-1( TIMP-1). Methods 135 cases from the hospitalized patients,who were diagnosed with CAPD or chronic kidney disease( CKD),were enrolled in the study. They were divided into four groups: CAPD group( 68 patients),CKD3 stage group,CKD4 stage group and CKD5 stage group. Left ventricular diastolic diameter( LVDd),interventricular septum thickness( IVST),left ventricular posterior wall thickness( LVPWT) were estimated by color Doppler ultrasonic cardiogram so as to calculate left ventricular mass index( LVMI) and relative left ventricular wall thickness( RLVT). The serum levels of MMP-10,MMP-8 and TIMP-1 were measured by ELISA.Results In the CAPD group,patients with thickened IVST accounted for 38. 23% and had the thickest IVST,with significant difference when compared with that in the CKD3 and CKD4 groups( P < 0. 05). The value of LVDd in the CAPD group was lower than that in the CKD5 group without significant difference,but was significantly higher than that in the CKD3 and CKD4 groups( P < 0. 05). Patients with left ventricular hypertrophy( LVH) and concentric hypertrophy each accounted for 48. 53% in the CAPD group,and their serum MMP-10,MMP-8 and TIMP-1 concentrations were much higher than those in the CKD group. Compared with the normal IVST subgroup,patients in the thickened IVST subgroup had higher serum MMP-10,MMP-8 and TIMP-1 concentrations,but only comparison of MMP-10 had statistical significance( P < 0. 05). There was no significant difference between the serum MMP-10,MMP-8 and TIMP-1 levels of concentric and non-concentric hypertrophy patients in the CAPD group. Similarly,no significant difference was found between the serum MMP-10,MMP-8 and TIMP-1 levels of LVH and non-LVH patients. The spearman linear correlation analysis in the CAPD group showed that,IVST value was positively related with serum MMP-10( r = 0. 382,P = 0. 010),TIMP-1( r = 0. 252,P = 0. 038) concentrations except MMP-8,and RLVT value was positively related with serum MMP-10( r = 0. 243,P = 0. 045) concentration,but correlation between LVDd and LVMI values and serum MMP-10,MMP-8,TIMP-1 concentrations was of no statistical significance. Conclusion The ventricular remodeling in the CAPD patients is more significant than that in the early CKD patients,and the existing remodeling in uremia patients could probably not be reversed by CAPD.There are correlation between ventricular remodeling in CAPD patients and serum levels of MMP-10 and TIMP-1.