非糖尿病维持性血液透析患者髓过氧化物酶与颈动脉硬化的相关性

Correlation of Myeloperoxidase and Carotid Atherosclerosis in Non-diabetic Patients with Maintenance Hemodialysis

目的探讨非糖尿病维持性血液透析患者髓过氧化物酶与颈动脉硬化相关指标的关系。方法酶联免疫吸附法测定非糖尿病维持性血液透析患者同一次透析前后血浆髓过氧化物酶和血清弹性蛋白酶水平变化,同时B超测定两侧颈总动脉内膜中膜厚度、斑块数量及面积,并对各项指标做相关性分析。结果血液透析后血浆髓过氧化物酶水平明显高于血液透析前(P<0.01),血清弹性蛋白酶水平透析前后无明显变化。年龄、血液透析前髓过氧化物酶水平与颈总动脉内膜中膜厚度明显正相关(P<0.01),血液透析后髓过氧化物酶水平与血液透析前后弹性蛋白酶水平无相关,与各项颈动脉硬化指标也无相关。结论年龄及血液透析前髓过氧化物酶水平与动脉硬化有关,而特定血液透析条件时血液透析后血浆髓过氧化物酶水平的升高与中性粒细胞脱颗粒及动脉硬化程度无关,可能是肝素诱发的动脉壁髓过氧化物酶释放,这种释放对维持性血液透析患者动脉硬化的意义有待进一步研究。

Aim To study possible clinical relationships of myeloperoxidase（MPO） and carotid atherosclerosis in non-diabetic patients with maintenance hemodialysis（MHD）.Methods Levels of plasma MPO and serum elastase（ELT） of non-diabetic patients with MHD were determined by ELISA.Carotid intima-media thickness（IMT）,quantity and area of carotid plaque were measured by B-mode ultrasonography.Results There was no significant difference of serum ELT before and after hemodialysis（HD）.Plasma MPO was significantly higher after HD than before HD（P0.01）.There was positive correlation between age,MPO level before HD and carotid IMT（P0.01）.There was no correlation between the levels of plasma MPO after HD and serum ELT or carotid IMT.Conclusions MPO level before HD contributed to carotid atherosclerosis in patients on MHD.In contrast,there was no relation between higher MPO level after HD and carotid atherosclerosis.This finding suggests that increased plasma MPO levels after HD do not reflect increased activation/degranulation of leukocytes and supports the view that the increase in circulating MPO reflects the heparin-induced release from the atherosclerotic vascular wall.