慢性肾衰竭患者血浆sCD40和sCD40L的变化

The changes of plasma soluble CD40 and soluble CD40L in patients with chronic renal failure and their clinical significance

目的探讨慢性肾衰竭（CRF）患者血浆中可溶性CIMO（sCD40）和可溶性CD40配体（sCD40L）的变化以及在肾损伤和免疫异常中的可能作用。方法选择2006年9月至12月首都医科大学附属北京同仁医院肾内科收治的慢性肾衰竭未透析患者（CRF组）30例，血液透析中心维持性血液透析3个月以上的尿毒症患者（HD组）30例，与患者年龄、性别相匹配的健康正常对照组20例。采用酶联免疫吸附法（ELISA）测定血浆sCD40和sCD40L的水平，并进行相关因素分析，观察血液透析对sCD40和sCD40L的影响。用方差分析和Pearson相关性分析进行统计学分析。结果（1）CRF组和HD组sCD40水平均明显高于对照组（P〈0．01），HD组sCD40水平较CRF组升高（P〈0．01）；（2）CRF组和HD组sCD40L水平均明显高于对照组（P〈0．01），HD组sCD40L水平较CRF组轻度升高，但无显著差异（P〉0．05）；（3）CRF组sCD40水平与血肌酐（Scr）和C-反应蛋白（CRP）之间成正相关（r=0．637，P〈0．01；r=0．551，P〈0．05），sCD40L水平与Ser和CRP之间也存在相关性（r=0．553，P〈0．05；r=0．686，P〈0．01），sCD40、sCD40L水平与血压、血红蛋白（Hb）、血小板（PLT）、白细胞（WBC）、血白蛋白（AIb）、血糖（Glu）、尿素氮（Bun）及血脂等指标之间无相关性（P〉0．05）。血液透析组sCD40、sCD40L与上述指标之间无相关性，与透析病程和透析充分性（Kt／V）之间也无相关性（P〉0．05）；（4）一次血液透析过程，HD后sCD40水平较HD前略有升高，差异无统计学意义（P〉0．05），HD后sCD40L水平较HD前下降，差异具有统计学意义（P〈0．01）。结论CRF患者血浆中sCD40和sCD40L水平升高，HD患者更明显，有可能参与CRF患者肾损伤和免疫异常。

Objective To investigate the changes of plasma soluble CD40 （sCD40） and soluble CD40L （sCD40L） in patients with chronic renal failure（CRF） and their potiential mechanisms in renal injury and immunodeficiency. Method From September to December 2006, 30 CRF patients without hemodialysis （CRF group） in department of Nephrology and 30 uremic patients receiving maintenance hemodialysis for more than 3 months （HD group） in dialysis center in Beijing TongRen Hospital of Capital Medical University, were enrolled in this study. The normal control group consisted of 20 healthy volunteers who matched with study subjects for age and gender. The levels of plasma sCD40 and sCD40L were measured by the method of enzyme linked immunosorbent assay （ELISA）. The relationship between sCD40, sCD40L and related factors were analyzed, and the influence of hemodialysis on sCD40 and sCD40L were observed. ANOVA and Pearson correlation analysis were used in statistical analysis. Results （ 1 ） The sCD40 levels in CRF group and HD group were significantly higher than those in control group （ P 〈 0.01 ）. The sCD40 levels in HD group were also higher than those in CRF group （ P 〈 0.01）. （2） The sCD40L levels in CRF group and HD group were significantly higher than those in control group （ P 〈 0.01 ）. The sCD40L levels in HD group were slightly higher than those in CRF group, but without significant diffrerence （ P 〉 0.05）. （3） In CRF group, the sCD40 levels correlated positively with serum creatinine （Scr） and C-reactive protein（CRP） （r = 0. 637, P 〈 0.01, r = 0. 551, P 〈 0.05）. The correlations between sCD40L and Scr and CRP were ＇also seen （ r = 0.553, P 〈 0.05, r = 0. 686, P 〈 0.01 ）, whereas the correlation with blood pressure, hemoglobin （Hb）, platelet （PLT）, white blood cell （ WBC ）, serum albumin （Alb）, glucose （Glu）, blood urea nitrogen（Bun） and serum lipid was no seen （P 〉 0.05）. In HD group, there were no correlations between sCD40, sCD40L and above parameters （ P 〉 0.05）, there were also no correlations between sCIMO, sCD40L and duration of the treatment by dialysis and dialysis adequacy（Kt/V） （P 〉 0.05）. （4）Mter one HD session, the post-HD levels of sCD40 were slightly higher than pre-HD levels, but without statistical difference （ P 〉 0.05）. The post-HD levels of sCD40L were obviously lower than pre-HD levels, with significant difference （ P 〈 0.01 ）. Conclusions The levels of sCD40 and sCD40L in CRF patients, particularly in HD patients, were significantly higher than those of controls, which may participate in pathogenesis of renal injury and immunodeficiency.