终末期肾病微炎症状态与左心室结构和功能损害的关系

Relationship between microinflammatory state of end-stage renal disease and structure and function impairment of left ventricle

目的研究终末期肾病(ESRD)的微炎症状态及其与左心室结构、功能损害的关系。方法检查60例ESRD患者和18例肾功能正常的肾炎患者血清C-反应蛋白(CRP)等炎症因子水平和心脏超声心动图指标,分析尿毒症微炎症状态及其与左心室结构、功能损害的关系。结果(1)ESRD患者血清中炎症性指标C-反应蛋白(CRP)、白细胞介素(IL)-6和肿瘤坏死因子(TNF)-α平均水平虽在正常范围,但明显高于对照组(P<0.05);(2)根据CRP水平分组后发现,CRP>4mg/L组,左心室肥厚比率及其它反映左室结构的多项超声心动图指标与CRP<4 mg/L组比较,差异有显著性;(3)CRP>4 mg/L组与CRP<4 mg/L组比较,E/A比值下降,每搏输出量(SV)、每分输出量(CO)升高,差异有显著性;(4)血清CRP浓度与左心室后壁厚度(PWT)、室间隔厚度(IVST)和左室质量指数(LVM I)呈显著正相关(P值均<0.01);与E/A比值呈显著负相关(P<0.01);与SV、CO亦呈显著正相关(P值均<0.05)。结论尿毒症患者体内存在微炎症状态,这种微炎症状态可能参与了尿毒症患者左心室结构和功能的损害。

Objective To study the microinflammatory state in end-stage renal disease （ESRD） patients and the reationship between microinflammatory state of end-stage renal disease and structure and fuction impaiment of left ventricle. Methods Inflammatory cytokines and echocardiographic data of 60 ESRD patients and 18 nephritis patients with normal renal fuction as control were collected. Results （ 1 ） The levels of inflammatory cytokines （CRP,IL-6,TNF-α） in ESRD patients were mostly in normal range, but still much higher than those in control. Acorrding to the level of CRP,the ESRD patients were divided into three？ （three or two？） groups：CRP 〉4mg/1 group and CRP 〈4mg/1 group. Significant difference of the percentage of left ventricular hypertrophy ,the ratio of E/A, stroke volume（SV） , cardiac minute volume （CO） and others echocardiographic index were found between the two groups. Blood serum CRP concentration correlated positively with left ventricular posterior wall thickness （PWT）） , interventricular septal wall thickness（IVST） and left ventricular mass index（LVMI） （P 〈 0.01 ） and inversely with the ratio of E/A（ P 〈 0.01 ）. The level of CRP also correlated positively with SV and CO （ P 〈 0.05 ）. Conclusion there is microinflammatory state in the ESRD patients. The microinflammatory state might be correlation closely with structure and function impairment of left ventricle of ESRD patients.