维持性血液透析患者血清胱抑素C与细胞因子及颈动脉病变的关系

Relationship of serum cystatin C level with cytokines and carotid atherosclerosis in maintenance hemodialysis patients

目的研究维持性血液透析（MHD）患者的血清胱抑素C（半胱氨酸蛋白酶抑制剂，CysC）水平的变化及其与细胞因子及颈动脉病变的关系。方法选择透析龄超过6个月的MHD患者110例（MHD组）和健康对照组60例为对象。用免疫透射比浊法检测CysC；超声检查颈动脉病变的程度；检测高敏C反应蛋白（hsCRP）、总同型半胱氨酸（tHcy）、血清白介素1β（IL-1β）、IL-6、肿瘤坏死因子α（TNF-α）水平。分析CysC水平与细胞因子及颈动脉病变的关系。结果MHD组血清CysC水平为（6．19±0．95）mg／L，显著高于健康对照组的（0．76±0．21）mg／L（P〈0．01）。MHD组hsCRP、tHcy、IL—1β、IL-6、TNF-α水平均显著高于健康对照组（P〈0．05或〈0．01）。MHD组患者颈动脉内膜中层厚度（IMT）及斑块形成、颈动脉硬化的患病率均显著高于健康对照组（P〈0．05或P〈0．01）。直线相关分析显示，MHD组血CysC水平与hsCRP、tHcv、IL-1β、IL-6、TNF-α、IMT及斑块形成、颈动脉硬化的患病率呈正相关；与透析龄、收缩压、iPTH亦呈正相关（P〈0．05或P〈0．01）。多因素逐步回归分析显示，CysC、hsCRP、tHcy和年龄是MHD患者颈动脉病变的危险因素。结论血液透析不能有效清除Cvsc等大分子物质，随着透析龄的增加，MHD患者血清CysC水平逐渐升高。CysC与hsCRP等微炎性反应指标及tHcy、颈动脉病变呈正相关，血清CysC水平升高可能是MHD患者并发动脉粥样硬化的危险因素之一。

Objective To investigate the serum cystatin C （CysC） level and explore its relationship with cytokines and atherosclerosis （AS） in maintenance hemodialysis （MHD） patients. Methods A total of 110 stable MHD patients undergoing hemodialysis for at least six months and 60 healthy control people were enrolled in the study. Serum levels of CysC and high-sensitivity C- reactive protein （hsCRP） were measured by immunoturbidimetry. The serum levels of total homocysteine （tHcy）, IL-1β, IL-6 and TNF-α were determined by ELISA. Prevalence of atherosclerosis was detected by carotid uhrasonography. The relationship of CysC level and cardiac geometry incidence in MHD patients was analyzed by Logistic regression model. Results The serum CysC level was significantly higher in MHD patients as compared with healthy controls [（6.19＋0.95） mg/L vs （0.76＋0.21） mg/L, P〈0.01], and the serum levels of hsCRP, tHcy, IL-1β,IL-6, TNF-α were significantly higher in MHD patients than those in healthy control group （P〈 0.05 or P〈0.01）. The serum CysC level was higher in MHD patients with carotid artery atherosclerosis compared to patients without carotid artery atherosclerosis （P〈0.05）. CysC was positively correlated with hsCRP, tHcy, IL-1β, IL-6, TNF-α respectively （P〈0.05 or P〈0.01）, and was positively correlated with carotid intimal medial thickness （IMT） and AS. Besides, a negative correlation was found between the serum CysC level and the serum albumin level （P〈0.05）, while CysC was positively correlated with dialysis duration, systolic pressure and iPTH （P〈0.05）. Conclusion Serum CysC level is significantly higher in MHD patients and is correlated with hsCRP, tHcy, IL-1β, IL-6, TNF-α as well as carotid artery atherosclerosis, which indicates that CysC is an independent risk factor of AS in MHD patients.