慢性肾脏病患者血浆中介素的变化及其与同型半胱氨酸、胱抑素-C的相关性研究

Study of changes of plasma intermedin level in patients with chronic kidney disease and its relationship with the levels of homocysteine and cystatin-C

目的：探讨中介素（IMD）在慢性肾脏病（CKD）时的水平变化及其与同型半胱氨酸（Hcy）、胱抑素-C（Cyc-C）的相关性。方法检测30例正常人和147例CKD患者血浆IMD、肾上腺髓质素（ADM）和转化生长因子β1（TGF-β1）的浓度，患者根据肾小球滤过率分为1～5期，分析三者在不同分期的变化及其与Hcy、Cyc-C的相互关系。结果（1）随着CKD分期的不同，患者β2微球蛋白、Cyc-C、Hcy、GFR、ADM、TGF-β1水平与对照组相比，差异均有统计学意义（P＜0.05），IMD含量差异无统计学意义（P＞0.05）。（2）GFR＞60 ml/min的CKD患者中不同病因类型中IMD的含量：与对照组相比，血浆IMD含量在肾病综合征组、IgA肾病组水平明显升高，差异有统计学意义（P＜0.05）；各组ADM含量与对照组相比，差异无统计学意义。各组TGF-β1含量均明显高于对照组（P＜0.05）。（3）GFR＞60 ml/min的CKD患者中：IgA肾病组：IMD与Cys-C、Hcy均呈显著正相关（r＝0.900、0.900，P均＜0.05）。结论血浆IMD、ADM和TGF-β1在CKD进展中呈现一定变化趋势，尤其在IgA肾病早期变化明显，且与血管损伤因子Hcy、Cyc-C具有正相关性，提示IMD和ADM可能参与CKD血管损伤的病理过程；而TGF-β1在肾纤维化过程中的变化，反映了机体自我调节的作用。

Objective To investigate intermedin （IMD） in patients with chronic kidney disease （CKD） and its relationship with the levels of homocysteine （Hcy）, cystatin-C （Cyc-C） correlation.Methods To detect 30 normal subjects and 147 patients with chronic kidney disease plasma IMD, ADM and TGF-β1 concentrations. Divided according to glomerular filtration rate in patients with stage 1-5, analyzed of changes of the three in different stages and its relationship with homocysteine, cystatin-C.Results Among the different stages of CKD, compared with control group, the β2 microglobulin, Cyc-C, Hcy, GFR, ADM, TGF-β1 levels were statistically significant （P〈0.05）, however, there was no significance in IMD （P〉0.05）. Among CKD patients （GFR〉60 ml/min） with different types of pathogeny, compared with the control group, the IMD of plasma levels was significantly increased in nephrotic syndrome group and IgA nephropathy group, the difference was statistically significant （P〈0.05）; but ADM showed no difference in each group. While TGF-β1 levels in each group were significantly higher （P〈0.05）, and the IMD and Cys-C, Hcy showed a significant positive correlation in the IgA nephropathy group （r=0.900, 0.900, allP〈0.05）.Conclusion The IMD, ADM and TGF-β1 show certain trends in the progression of chronic kidney disease, especially in the early stage of IgA nephropathy, as well as vascular injury factors homocysteine and cystatin-C.The research suggest that IMD and ADM may involved in the pathological process of vascular injury in CKD; while TGF-β1 reflect the role of self-regulation in renal fibrosis.