阿托伐他汀对早期慢性肾脏病伴颈动脉斑块患者外周血淋巴细胞基质金属蛋白酶血管性假血友病因子的作用

Effects of atorvastatin on MMPs and vWF in peripheral blood lymphocytes in patients of early chronic kidney disease with carotid artery plaque

目的探讨阿托伐他汀对早期慢性肾脏病(CKD)伴有颈动脉斑块患者周围血淋巴细胞基质金属蛋白酶(MMPs)、血管性假血友病因子(vWF)的作用。方法选取2017年1月至10月上海市第六人民医院东院和菏泽市立医院肾脏科就诊的143例CKD 1~2期并颈动脉斑块患者,按随机数字表法分为CKD组(n=76)和治疗组(n=67),并选择同期健康体检正常者50例作为对照组,治疗组口服阿托伐他汀。治疗6个月后比较3组患者血脂水平和颈动脉内膜中层厚度(IMT),并比较3组患者治疗第1,2,3,6个月后外周血淋巴细胞MMP-2、MMP-9及vWF水平的变化。结果与对照组比较,CKD组和治疗组在治疗第6个月后甘油三酯[(1.42±0.40)mmol/L,(3.58±0.78)mmol/L,(1.78±0.46)mmol/L]、总胆固醇[(4.56±0.78)mmol/L,(6.88±1.39)mmol/L,(5.16±1.14)mmol/L]水平、IMT[(0.78±0.23)mm,(1.56±0.43)mm,(1.06±0.22)mm]和外周血淋巴细胞MMP-9[(124.10±42.96)μg/L,(232.82±90.16)μg/L,(158.57±57.14)μg/L]、MMP-2[(141.09±44.98)μg/L,(262.82±110.98)μg/L,(154.48±56.86)μg/L]及vWF水平[(111.68±42.29)μg/L,(276.82±111.68)μg/L,(142.32±46.44)μg/L]明显升高,均差异有统计学意义(F=5.90,4.28,3.45,11.34,12.45,12.35,均P<0.05),但治疗组甘油三酯、总胆固醇、IMT、MMP-9、MMP-2和vWF水平与CKD组比较均降低,均差异有统计学意义(t=4.21,1.22,5.13,4.90,5.90,10.00,均P<0.05)。结论阿托伐他汀可能通过降低早期CKD伴颈动脉斑块患者外周血淋巴细胞MMP-2、MMP-9和vWF水平,起到稳定斑块的作用。

Objective To explore the effects of atorvastatin on matrix metalloproteinase(MMPs)and von Willebrand factor(vWF)in peripheral blood lymphocytes in patients of early chronic kidney disease(CKD)with carotid artery plaque.Methods From January to October 2017,143 patients with stage 1-2 CKD and carotid artery plaque who visited the Kidney Department of the East Hospital of Shanghai Sixth People′s Hospital and Heze Municipal Hospital were selected.According to the random number table method,they were divided into the CKD group(n=76)and the treatment group(n=67),and 50 healthy people with normal physical examination in the corresponding period were selected as the control group.The treatment group was treated with atorvastatin for oral administration.After 6 months of treatment,blood lipid level and carotid intima-media thickness(IMT)of the 3 groups were compared,and the changes of MMP-2,MMP-9 and vWF levels of peripheral blood lymphocytes in the 3 groups were compared after 1,2,3 and 6 months of treatment.Results Compared to the control group,after 6 months of treatment,the triglycerides levels[(1.42±0.40)mmol/L,(3.58±0.78)mmol/L,(1.78±0.46)mmol/L],total cholesterol levels[(4.56±0.78)mmol/L,(6.88±1.39)mmol/L,(5.16±1.14)mmol/L],IMT levels[(0.78±0.23)mm,(1.56±0.43)mm,(1.06±0.22)mm]and peripheral blood lymphocytes of MMP-9 levels[(124.10±42.96)μg/L,(232.82±90.16)μg/L,(158.57±57.14)μg/L],MMP-2 levels[(141.09±44.98)μg/L,(262.82±110.98)μg/L,(154.48±56.86)μg/L]and vWF levels[(111.68±42.29)μg/L,(276.82±111.68)μg/L,(142.32±46.44)μg/L]in the CKD group and treatment group were significantly increased,with statistically significant differences(F=5.90,4.28,3.45,11.34,12.45,12.35,all P<0.05).The levels of triglyceride,total cholesterol,IMT,MMP-9,MMP-2 and vWF levels in the treatment group were lower than those in the CKD group,all the differences were statistically significant(t=4.21,1.22,5.13,4.90,5.90,10.00,all P<0.05).Conclusions In early CKD patients with carotid artery plaque,atorvastatin may play a role in stabilizing plaques by reducing MMP-2,MMP-9 and vWF levels in peripheral blood lymphocytes.