中老年慢性肾脏病患者动脉硬化程度的比较

Comparison of arteriosclerosis degree between middle-aged and elderly patients with chronic kidney disease

目的对中老年慢性肾脏病（cKD）患者的动脉硬化程度进行比较，探讨静脉血中炎性蛋白分子与动脉硬化的关系。方法选取慢性肾脏病老年患者87例，中年患者64例。晨起空腹采取静脉血，ELISA法检测血清白细胞介素（IL）、肿瘤坏死因子（TNF-α）、超敏C-反应蛋白（hs-CRP），同时测量患者踝臂脉搏波传导速度（baPwV）。结果两组患者血中炎性蛋白分子IL-18、IL-6、TNF-n和hs-CRP水平均随慢性肾脏病的严重程度增加而增高，且老年组高于中年组；baPWV〉1400cm／s检出率老年组（30例，34．5％）高于中年组（11例，17．2％），差异有统计学意义（X^2-5．58，P〈0．05）老年组并存高脂血症和高血压者PwV〉1400cm／s的比率分别为100．0％和100．0％，高于并存糖尿病（45．5％）和心脏病者（40．0％），差异有统计学意义（P〈0．05）；在baPWV〉1400cm／s的患者中，静脉血中炎性蛋白分子IL-18、IL-6、TNF-β和hs-CRP水平均高于baPWV〈1400cm／s的患者，差异有统计学意义（P〈0．05）。结论老年慢性肾脏病患者的动脉硬化程度较中年患者更加严萤，需引起足够莺视。

Objective To compare the degree of atherosclerosis in middle-aged versus elderly patients with chronic kidney disease （CKD）, and to explore the relationship between inflammatory molecules in venous blood and atherosclerosis. Methods Totally 87 elderly patients and 64 middle- aged patients with CKD were selected. The vein fasting blood samples were taken in the morning. Serum levels of interleukin （IL）-18, IL-6, tumor necrosis factor （TNF-α）, high-sensitivity C-reactive protein （hs-CRP） were measured by enzyme-linked immunosorbent assay （ELISA） and ankle-brachial pulse wave conduction velocity （baPWV） was detected. Results Inflammatory molecules such as IId8, IL-6, TNF-α and hs-CRP levels in venous blood were increased with the severity of CKD in both two groups, and the levels of inflammatory molecules were higher in elderly group than in middle-aged group. There was a signifiant difference in the detection rate of patients with baPWV） 1400 cm/s between elderly group and middle-aged group （30 cases （34.5%） vs. 11 cases （17.2%）, ）X2 = 5.58, P〈0.05]. The prevalence of PWV〉 1400 cm/s was higher in patients with hyperlipidemia and hypertension than in patients with diabetes or heart disease （elderly group： 100%, 100% vs. 45.5%0, 40%; middle-aged group： 80%, 100% vs. 28.6%, 33.3%, respectively; P（0.05）. The inflammatory protein （IL-18, IL-6, TNF-α and hs-CRP） levels were significantly higher in patients with baPWV〉 1400 cm/s than those with baPWV 〈1400 cm/s （P〈0.05）. Conclusions The degree of atherosclerosis is more severe in elderly CKD patients than in middle-aged CKD patients, which needs to be taken seriously enough.