慢性乙型肝炎血液透析患者动脉粥样硬化与血清肝细胞生长因子表达的研究

Incidence of atherosclerosis in hemodialysis patients with chronic hepatitis B infection and its association with serum hepatocyte growth factor

目的评价慢性乙型肝炎血液透析患者(hemodialysis patient with chronic hepatitisB,CHB-HD)动脉粥样硬化的情况及血清肝细胞生长因子(hepatocyte growth factor,HGF)的水平,分析二者的相关性。方法以43例CHB-HD患者为观察对象,以46例普通血液透析(HD)患者作为对照,采用超声测定颈动脉内-中膜厚度(IMT)、粥样硬化斑块,检测生化指标、全段甲状旁腺激素(iPTH)、超敏C反应蛋白(hs-CRP)、血红蛋白(Hb)、血清HGF水平。比较CHB-HD与HD患者动脉粥样硬化、血清HGF及其他生化指标的差异,并分析CHB-HD患者动脉粥样硬化可能的危险因素。结果 CHB-HD与HD患者相比,动脉粥样硬化发生率明显增加(41.89%vs.21.74%,P<0.05),血清HGF水平明显升高[(1040.98±259.45)pg/mlvs.(893.98±259.48)pg/ml,P<0.05]。在CHB-HD患者中,动脉粥样硬化患者的血清HGF水平明显高于无动脉粥样硬化患者[(1167.76±246.57)pg/mlvs.(924.35±189.20)pg/ml,P<0.05]。CHB-HD患者的Hb、白蛋白(ALB)、前白蛋白(PALB)、总胆固醇(TC)明显低于HD患者。Logistic回归显示CHB-HD患者血清HGF水平是其动脉粥样硬化的独立危险因素(OR=1.007,P=0.044)。结论 CHB-HD患者动脉粥样硬化更为显著,血清HGF亦明显升高,HGF可能参与其动脉粥样硬化的发生、发展。

Objective To investigate the incidence of atherosclerosis in hemodialysis patients with chronic hepatitis B （CHB-HD） infection and its association with serum hepatocyte growth factor （HGF）. Methods Two groups of patients were included for investigation： 43 HD patients with CHB （CHB-HD group） infection as the study group, and 46 HD patients with non-CHB （HD group） infection as the control group. Carotid artery intima-media thickness （CA-IMT）, atherosclerotic plaque was measured by high-resolution B-mode ultrasonography. Their serum HGF levels were determined by enzyme linked immunosorbent assay. Biochemical parameters, hs-CRP and iPTH were also measured. The differences between the two groups were analyzed and the risk factors of atherosclerosis in CHB-HD patients were determined. Results Compared with ordinary HD patients, the incidence of atherosclosis in CHB-HD patients were markedly higher （41.86% vs. 21.74 % ,P 〈 0.05）, and serum levels of HGF in CHB-HD patients were also significantly higher than those in HD patients [（1040.98±259.45） pg/ml vs. （893.98±259.48） pg/ml, P 〈 0.05]. In CHB-HD patients, serum levels of HGF in atherosclerotic patients were significantly increased than those patients without atheroselerosis [（167.76±246.57）pg/ml vs. （924.35±189.20）pg/ml, P 〈 0.05]. Logistic regression revealed that serum levels of HGF as an independent risk factor of atherosclerosis （OR = 1.007, P = 0.004）. Conclusions The incidence of atherosclerosis in maintenance hemodialysis patients with chronic hepatitis B is higher than ordinary HD patients, and the serum levels of HGF are also significantly increased. HGF may be associated with the occurrence and development of atherosclerosis in maintenance hemodialysis patients with chronic hepatitis B infection.