慢性肾脏病患者外周血CD36的表达及其临床意义

The expression of peripheral blood CD36 and its clinical significance in patients with chronic kidney disease

目的探讨慢性肾脏病(chronic kidney disease,CKD)患者外周血CD36的表达情况及其可能的影响因素,并观察其与患者的临床心血管疾病的关系。方法选取上海交通大学医学院附属仁济医院77例CKD患者和10例健康志愿者,收集患者的临床资料,并进行血生化、超声心动图和颈动脉超声检查,流式细胞仪检测外周血CD36水平,比较CKD1～3期、CKD4～5期患者和对照组患者外周血CD36水平,并分析其与血脂代谢、炎症指标、颈动脉斑块及左心室肥厚的关系。结果 CKD1～3期组(n=36)、CKD4～5期组(n=41)和对照组患者的外周血CD36的绝对计数分别为(476.73±191.41)×105/L、(1463.61±592.90)×105/L和(68.55±12.73)×105/L,CKD4～5期组患者的外周血CD36水平显著高于CKD1-3期组患者(P<0.01),CKD l～3期组又显著高于健康对照组(P<0.01)。左心室肥大患者的CD36水平显著高于非左心室肥大患者[(1255.07±704.20)×105/L比(805.34±586.20)×105/L,P<0.05]。多元回归分析显示,CD36是影响颈动脉斑块形成的独立危险因素(β=0.295,P=0.010)。逐步多元线性回归分析显示,eGFR(β=-0.301)和三酰甘油(β=-0.294)是影响CKD患者外周血CD36水平的独立危险因素(P值均<0.01)。结论 CKD患者的外周血CD36水平显著升高,其与患者的肾功能减退和脂质代谢紊乱密切相关,可能造成动脉粥样斑块的形成及左心室肥大的发生。

Objective To investigate the expression of peripheral blood CD36 level,its influence factors,and its clinical significance in patients with chronic kidney disease.Methods A total of 77 chronic kidney disease (CKD) patients and 10 healthy subjects were included in this study.Clinical data was collected.Blood tests,echocardiogram and carotid artery ultrasound were taken.The number of CD36+ cells in whole blood was determined by a flow cytometer and compared among patients with CKD stage 1～3,Stage 4～5 and healthy subjects.Its correlations with lipid,inflammation indices,carotid plaques and left ventricular hypertrophy were analyzed.Results The CD36+ level was significantly higher in patients at CKD stage 1～3 and CKD stage 4～5 than in control subjects [(476.73±191.41)×105/L,(1463.61±592.90)×105/L and (68.55±12.73)×105/L,respectively,P<0.01],and was significantly higher in patients at CKD stage 4～5 than in patients at CKD stage 1～3 (P<0.01).The CD36+ level was significantly higher in patients with left ventricular hypertrophy than in those without left ventricular hypertrophy [(1255.07±704.20)×105/L vs (805.34±586.20)×105/L,P<0.05].Multiple regression analysis showed that the CD36+ level in whole blood was an independent risk factor for carotid artery plaque (β=0.295,P=0.010).Multiple linear regression analysis showed that eGFR (β-0.301,P<0.01) and triglyceride (β-0.294,P<0.01) were the stronger independent determinants of the CD36+ level.Conclusion The CD36+ level in whole blood was elevated in CKD patients.The increase of CD36+ level was closely associated with renal function deterioration and dyslipidemia,and might relate to left ventricular hypertrophy and atherosclerosis.