腹膜透析患者同型半胱氨酸和超敏CRP对血管内皮细胞功能的影响

Effects of homocysteine and hypersensitive CRP on endothelial cell function in peritoneal dialysis patients

目的探讨腹膜透析患者同型半胱氨酸(Hcy)和超敏CRP(Hs-CRP)对血管内皮细胞功能的影响。方法选取45例腹膜透析患者作为研究对象,采用酶联免疫吸附法测定患者Hcy,根据Hcy是否>15μmol/L将患者分为高Hcy血症组和血Hcy正常组;采用免疫比浊法测定患者Hs-CRP,根据Hs-CRP是否>10μg/m L将患者分为高Hs-CRP血症组和血Hs-CRP正常组。检测比较高Hcy血症组与血Hcy正常组、高Hs-CRP血症组与血Hs-CRP正常组患者的颈动脉内膜中层厚度(IMT)、一氧化氮(NO)、内皮型NO合成酶(e NOS)水平以及反应性充血后血管内径变化率(FMD),并对腹膜透析患者FMD与Hcy、Hs-CRP水平的关系进行相关性分析。结果高Hcy血症组、高Hs-CRP血症组患者IMT厚于血Hcy正常组及血Hs-CRP正常组;高Hcy血症组、高Hs-CRP血症组FMD及NO、e NOS水平低于血Hcy正常组、血Hs-CRP正常组,差异具有统计学意义(P<0.05);Spearman等级相关和多重线性回归分析结果显示,腹膜透析患者FMD与Hcy、Hs-CRP水平均呈负相关(P<0.05)。结论腹膜透析高Hcy血症、高Hs-CRP血症患者IMT明显增厚,NO、e NOS、FMD水平显著降低,Hcy和Hs-CRP水平可能是影响其血管内皮细胞功能的危险因素。

Objective To investigate the effect of homocysteine（Hcy） and hypersensitive CRP（Hs-CRP） on endothelial cell function in patients on peritoneal dialysis. Methods A total of 45 peritoneal dialysis patients were selected as objects,and enzyme-linked immunosorbent assay（ELISA） was used to detect the level of Hcy,while the level of Hs-CRP was tested by immunoturbidimetry,then 45 peritoneal dialysis patients were divided into hyper Hcy group,Hcy normal group,hyper Hs-CRP group and Hs-CRP normal group according to whether Hcy was 〉15 μmol/L,or Hs-CRP was 〉10 μg/m L. FMD,IMT and the levels of NO,e NOS of all patients were measured,and the relationship between FMD and the levels of Hcy,Hs-CRP was analyzed.Results IMT in the hyper Hcy group was significantly thicker than that in the Hcy normal group,FMD and the levels of NO,e NOS in the hyper Hcy group was significantly lower than those in the Hcy normal group（P 〈0. 05）; IMT in the hyper Hs-CRP group was significantly thicker than that in the Hs-CRP normal group,FMD and the levels of NO,e NOS in the hyper Hs-CRP group was significantly lower than those in the Hs-CRP normal group（P 〈0. 05）; Spearman rank correlation and multiple linear regression analysis showed that FMD had a negative correlation with Hcy and Hs-CRP（P〈 0. 05）. Conclusions Peritoneal dialysis patients in hyper Hcy and hyper Hs-CRP has high level of IMT,and low level of the level of NO,e NOS,FMD,the level of Hcy and Hs-CRP may be the risk factors that impact on vascular endothelial cell function.