腹膜透析患者循环内皮细胞与动脉粥样硬化的关系

Association between circulating endothelial cells and atherosclerosis in continuous ambulatory peritoneal dialysis patients

目的探讨持续性非卧床腹膜透析（CAPD）患者循环内皮细胞（CEC）与动脉粥样硬化（AS）的关系。方法选取CAPD患者42例,慢性肾脏病4~5期非透析（CKD.non.HD）患者17例（HD组）及健康对照组16例,收集有关临床参数,采集外周血,检测CEC数目、血红蛋白（Hb）、血细胞比容（Hct）、血钙（Ca）、血磷（P）、清蛋白（Alb）、甲状旁腺素（PTH）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）等指标,检测颈总动脉内中膜厚度（CCA-IMT）,计算残余肾功能（RRF）、溶质清除率（Kt/V）和内生肌酐清除率（Ccr）,对CEC与CCA-IMT及有关参数进行相关和回归分析。结果 CAPD组及HD组CEC较健康对照组明显升高（P〈0.05）;CAPD组CEC较HD组明显升高（P〈0.05）。CAPD组及HD组CCA-IMT较健康对照组明显增厚（P〈0.05）,CAPD组CCA-IMT较HD组明显增厚（P〈0.05）。CAPD组、HD组、健康对照组CEC与CCA-IMT呈正相关。CEC是CAPD组CCA-IMT的独立危险因素。结论 CEC是CAPD患者AS的独立危险因素,可作为评价CAPD患者血管内皮损伤程度的新指标。

Objective To explore the association between circulating endothelial cells（CECs） and atherosclerosis in continuous ambulatory peritoneal dialysis（CAPD）patients.Methods A crosssectional study was performed to investigate the association between CECs and carotid atherosclerotic change in 42 CAPD patients,17 non-hemodialysis（non-HD）patients with chronic kidney disease（CKD）of stage 4 or 5（CKD-non-HD）and 16 age-and sex-matched healthy controls.The clinical parameters were collected,peripheral blood was collected for detecting number of CECs,hemoglobin（Hb）,hematocrit（Het）,serum calcium（Ca）,serum phosphorus（P）,serum albumin（Alb）,serum parathyroid hormone（PTH）,cholesterol（TC）,triglyceride（TG）,high density lipoprotein（HDL）,low density lipoprotein（LDL）,etc.The carotid artery intima-media thickness（CCA-IMT）was measured.Results CECs were significantly higher in CAPD patients and CKD-non-HD patients compared with the control group（P0.05 and P0.05,respectively）.CECs were significantly higher in CAPD patients compared with CKD-non-HD patients（P0.05）.CCA-IMT was also significantly higher in CAPD patients and CKD-non-HD patients compared with the control group（P0.05 and P0.05,respectively）.CCA-IMT was also significantly higher in CAPD patients compared with CKD-non-HD patients（P0.05）.The number of CECs was positively correlated with CCA-IMT in CAPD patients,CKD-non-HD patients and control group.Multivariate analysis showed that CEC level was a strong independent risk factor of CCA-IMT in CAPD patients.Conclusion In CAPD patients,CEC level is associated with carotid atherosclerosis and may be used as a marker to evaluate the endothelial damage.