慢性肾脏病患者血清总胆红素水平与颈动脉内膜中膜厚度的关系

Correlation Between Serum Total Bilirubin Level and Intima-media Thickness of Carotid Artery in Chronic Kidney Disease Patients

目的观察慢性肾脏病患者血清胆红素水平变化与颈动脉内膜中膜厚度的关系。方法选择慢性肾脏病患者48例和对照组16例,测定血清胆红素水平,用高分辨二维颈动脉超声技术测定颈动脉内膜中膜厚度及粥样硬化斑块。结果慢性肾脏病患者血清胆红素水平明显低于对照组(P<0.01);血清胆红素水平随肾功能降低而减低。平均颈动脉内膜中膜厚度和动脉粥样斑块检出率明显高于对照组(P<0.01)。慢性肾脏病伴颈动脉硬化组较无颈动脉硬化组血清胆红素(5.38±1.95μmol/L比9.15±3.53μmol/L)水平明显降低(P<0.01);慢性肾脏病患者血清胆红素与尿素氮、肌酐呈显著负相关(r=-0.611和-0.492,P<0.0001),与肾小球滤过率、血红蛋白呈显著正相关(r=0.693和0.602,P<0.0001)。血清总胆红素(β=0.918,P=0.004)是慢性肾脏病患者并发动脉粥样硬化的独立危险因素。结论慢性肾脏病患者存在低胆红素血症,低胆红素血症可能参与了慢性肾脏病患者动脉粥样硬化的发生和发展。

Aim To investigate the correlation between serum total bilirubin level and intima-media thickness（IMT） of carotid artery in chronic kidney disease（CKD） patients.Methods Forty-eight non-dialytic CKD patients and sixteen healthy volunteers were involved in the study.CKD patients were classified into three groups according to glomerular filtration rate（GFR）： CKD 2-3 stage,CKD 4 stage and CKD 5 stage.Their serum bilirubin levels were measured and compared.Intima-medial thickness of carotid artery and the presence of atherosclerotic plaques were determined by using noninvasive high-resolution B-mode ultrasonography.Results Sermu total bilirubin,IMT and prevalence of atherosclerotic plaques in CKD patients were significantly lower than those in healthy groups（P0.01）.The serum total bilirubin will lower following with the decreased renal function.The serum total bilirubin and concentrations were significantly decreased in CKD patients with atherosclerosis of carotid artery group（5.38±1.95 μmol/L vs 9.15±3.53 μmol/L,P0.01）.The linear correlation analysis indicated the serum total bilirubin was correlated negatively with urea nitrogen and serum creatinine（r-0.611,P0.0001;r-0.492,P0.0001）.The serum total bilirubin level was correlated positively with glomerular filtration rate and hemoglobin（r0.693,P0.0001;r0.602,P0.0001）.Logistic regression analysis further indicated that serum total bilirubin（β0.918,P0.004） was an independent risk factor of atherosclerosis in non-dialytic CKD patients.Conclusions Hypobilirubinemia exists in the patients of CKD.The serum bilirubin was significantly correlated with IMT.Hypobilirubinemia was an independent risk factor and might play a role in pathogenesis and progression of atherosclerosis.