慢性肾病患者循环内皮细胞微颗粒水平的变化

Variation of Circulating Endothelial Microparticles in Patients with Chronic Kidney Disease

目的比较慢性肾病(CKD)患者与健康对照组血浆中内皮细胞微颗粒(EMPs)、血管性血友病因子(vWF)水平的变化,探讨EMPs在CKD中的意义。方法采用流式细胞术及酶联免疫吸附试验(ELISA法)检测72例CKD患者和20名健康对照者血浆中EMPs、vWF的水平,并分析EMPs水平与血压、肌酐清除率、24h尿蛋白定量、血红蛋白、胆固醇之间的关系。结果CKD组患者血浆EMPs和vWF水平较健康对照组均显著增高;肾病综合征组EMPs的水平明显高于高血压肾病组,肾病综合征组vWF的水平明显高于高血压肾病组及慢性肾炎组,以上差异均有统计学意义(P<0.05或P<0.01)。CKD分期中Ⅰ期血浆中EMPs含量明显高于Ⅳ期,差异有统计学意义(P<0.05);其余各期间EMPs和vWF水平的差异均无统计学意义(P>0.05)。EMPs的水平与血压成正相关(P<0.05),与肌酐清除率、24h尿蛋白定量、血红蛋白、胆固醇均无明显相关性(P>0.05)。vWF与EMPs成正相关(P<0.05)。结论CKD患者存在内皮功能障碍,高血压是使内皮功能异常的重要原因之一,EMPs可作为一种反映内皮功能的新标记。

Objective To compare the levels of EMPs and vWF in patients with chronic kidney disease（CKD） and in the control group, to explore the significance of the EMPs in CKD. Methods Both in 72 cases of CKD and 20 cases of healthy controls,circulating EMPs were numerated by flow cytometry, vWF was measured by the enzyme-linked immunosorbent assay. The relationships between the level of EMPs and blood pressure, creatinine clearance, 24 h urinary protein, hemoglobin, cholesterol was investigated. Results Plasma levels of EMPs and vWF were significantly higher in CKD patients than that in the control group （P〈0.01）. The levels of EMPs in nephritic syndrome group was markedly higher than that in the hypertensive renal disease group （P〈0.05）.Meanwhile, the level of vWF in nephritic syndrome group was remarkably higher than that in the hypertensive renal disease group and chronic glomerulonephritis group（P〈0.01 and 〈0.05）. In different stages of CKD, the level of EMPs in stage Ⅰwas significantly higher than that in the stage Ⅳ（P〈0.05）, the plasma vWF levels between other stages were not significantly different （P〉0.05）.As for EMPs, a positive correlation was found with blood pressure, no correlation was found among creatinine clearance, 24 h urinary protein, hemoglobin and cholesterol, vWF has a positive correlation with EMPs. Conclusion Patients with CKD has endothelial dysfunction.Hypertension is one of the important reason for endothelial dysfunction.As a new marker, EMPs can reflect the endothelial function.