慢性肾脏病患者血清β_2微球蛋白与颈动脉粥样硬化的关系

Serum beta-2 microglobulin level is associated with carotid atherosclerosis in patients with chronic kidney disease

目的研究慢性肾脏病(CKD)患者血清?2微球蛋白(2MG)水平的变化及与颈动脉粥样硬化的关系。方法对168例CKD患者(非透析治疗120例,血液透析48例)的临床及实验室资料作回顾性研究,采用电化学发光免疫法(ECLIA)检测血清?2MG水平,应用颈动脉超声检查颈动脉病变的程度,分析?2MG水平与颈动脉粥样硬化的关系。结果 CKD患者无论透析与否,?2MG水平均较健康对照组显著升高[(18.6±2.91)比(2.18±0.49)μg/mL,P<0.01],在非透析CKD患者中,随着肾小球滤过率(GFR)的逐渐下降,血?2MG水平也逐渐升高,各组间比较差异有统计学意义(P<0.05或P<0.01),且CKD5D期?2MG水平较CKD5期更高(P<0.05);CKD患者颈动脉内膜中层厚度(IMT)[(0.71±0.18)比(0.67±0.21)mm,P<0.01]及斑块形成(28.7%比12.0%,P<0.01)、颈动脉硬化的患病率(32.9%比12.0%,P<0.01)较健康对照组均显著升高,CKD5D期上述指标较CKD5期均更高(均P<0.05);直线相关分析显示,血?2MG水平与hsCRP、TG、Lp(a)、血磷、iPTH、24h尿蛋白定量、透析龄及IMT、斑块形成、颈动脉硬化的患病率呈正相关(P<0.05或P<0.01),而与GFR、血白蛋白(SAlb)、血红蛋白(Hb)、血钙呈负相关(P<0.05或P<0.01);多因素逐步回归分析显示,?2MG、hsCRP和年龄是CKD患者颈动脉病变的独立危险因素。结论各期CKD患者?2MG水平均显著升高,且与hsCRP及颈动脉病变相关,血?2MG升高可能是CKD患者并发动脉粥样硬化的危险因素之一。

Objective To investigate the serum beta-2 microglobulin （β2MG） level and to explore its correlation with atherosclerosis （AS） in chronic kidney disease （CKD） patients.Methods Clinical and laboratory data of 168 CKD patients stratified by their GFR （based on the National Kidney Foundation/Kidney Dialysis Outcomes Quality Initiatives） were recruited and analyzed.Fifty healthy individuals were used as the controls.Serum β2MG was determined by electrochemiluminescence immunoassay （ECLIA）.High-sensitivity C-reactive protein （hsCRP） was measured by immunoturbidimetry.AS was detected by carotid ultrasonography.Logistic regression was used to analyze the relationship between β2MG level and carotid AS in CKD patients.Results Serum β2MG level was significantly higher in CKD patients even in the early stage of CKD as compared with that in the healthy controls （18.6±2.91 vs.2.18±0.49 μg/mL,P＜0.01）.Serum β 2MG increased with the progression of renal dysfunction.In the CKD2～5 groups,serum β2MG was negatively related to GFR （P＜0.05） and positively related to proteinuria （P＜0.05）,while in the CKD5D group,β2MG level was positively related to dialysis duration （P＜0.05）.Serum β2MG was higher in CKD patients with carotid AS than in the patients without carotid AS （P＜0.05 or ＜0.01）.Carotid intimal medial thickness （IMT） and the prevalence of carotid AS were significantly higher in CKD patients even at the early stage of CKD as compared with those of healthy controls （0.71±0.18 vs.0.67±0.21 mm,P＜0.01; 32.9％ vs.12.0％,P＜0.01）.Linear correlation analyses showed that serum β2MG level was positively correlated with hsCRP,TG,Lp（a）,phosphate,iPTH,24 h urinary protein,dialysis vintage,IMT,AS formation,and prevalence of carotid AS （P＜0.05 or ＜0.01）,and was negatively correlated with GFP,serum albumin,Hb,and serum calcium （P＜0.05 or ＜0.01）.Multivariate regression analyses demonstrated that β2MG,hsCRP and age were the independent risk factors for carotid AS in CKD patients.Conclusion Serum β2MG increases significantly in CKD patients at every stage,and is correlated with the increases of hsCRP and carotid AS.Serum β2MG level is an independent risk factor for carotid AS in CKD patients.