尿毒症患者微炎症与血管功能损伤的关系

Relationship Between Vascular Function Destroy and Microinflammation in the Pre-dialysis Patients with Remia

目的探讨尿毒症非透析患者微炎症与血管损伤的关系。方法选择95例尿毒症患者和40例健康对照者,用高分辨B超测颈动脉内膜中膜厚度、切面内膜中膜面积和粥样斑块以及测定肱动脉血管舒张功能。酶联免疫吸附法测定血清C反应蛋白和肿瘤坏死因子α含量。结果与健康对照组比较,尿毒症患者血清C反应蛋白(5.27±1.18mg/L比1.54±0.82mg/L,P<0.05)和肿瘤坏死因子α(2.11±0.34μg/L比0.15±0.03μg/L,P<0.05)含量显著升高(P<0.05),血清前白蛋白和血红蛋白显著降低(P<0.05),收缩压和舒张压明显升高(P<0.05),而血清白蛋白、血糖和血脂无显著变化。与健康对照组比较,虽然颈动脉内膜中膜厚度、切面内膜中膜面积、粥样斑块检出率及肱动脉基础内径和基础血流量差异无显著性,但是肱动脉内皮依赖性舒张功能、非内皮依赖性舒张功能、反应性充血血流量及含服硝酸甘油血流量均显著降低。C反应蛋白和肿瘤坏死因子α含量与肱动脉内皮依赖性舒张功能呈负相关(r分别为-0.76、-0.66,P<0.05),C反应蛋白和肿瘤坏死因子α含量与肱动脉非内皮依赖性舒张功能也呈负相关(r分别为-0.41、-0.48,P<0.05)。结论非透析尿毒症患者微炎症反应与血管功能损伤有关。

Aim To investigate the relationship between vascular function destroy and microinflammation in the patients with uremia before dialysis. Methods 95 patients were selected randomizedly as test group, and 40 normal individuals as control. Carotid artery intima-media thickness （IMT）, cross-sectional calculated intima-media area （IMA）, plaques, endotheliurn- dependent dilation （EDD） and endothelium-independent dilation （EID） of brachial artery were determined with non-invasive high-resolution B-mode ultrasonography. Serum levels of C-reactive protein （CRP） and tumor necrosis faetor-α （TNF-α） were also determined. Results Compared with normal eontrol, levels of serum CRP （5.27± 1.18 mg/L vs 1.54±0.82 mg/L, P 〈0.05）, TNF-α （2.11 ±0.34 μg/L vs 0.15±0.03 μg/L,P 〈0.05）were signifieantly higher, in patients with uremia. Lower levels of serum proalbumin and hemoglobin, and higher systolic and diastolic pressure were found in the patients. However, it has no difference about serum albumin, glucose and lipids between the two groups. There was no difference in IMT, IMA, pereentage of plaques, basal inner diameter and blood flow of brachial artery between the two groups. But, endothelium- dependent dilation （EDD）, endothelium-independent dilation （EID）, blood flow of response hyperemia, blood flow after bueeal nitroglycerin of braehial artery were decreased significantly in the patients group. Serum levels of CRP and TNF-α were correlated negatively with EDD and FAD （ P 〈 0.05 ）. Conclusion Thaese data suggest that the micrinflammation plays an important role in the pathogenesis of vascular dysfunction in the pre-dialysis patients with uremia.