终末期肾脏病患者CD＋4CDnull28T细胞和左心室肥厚的关系

Relationship of CD＋4CDnull28 T cells with left ventricular hypertrophy in end-stage renal disease patients

目的 探讨终末期肾脏病（ESRD）患者CD＋4CDnull28T淋巴细胞亚群比例与机体微炎症状态及左心室肥厚（LVH）的关系.方法 选取ESRD患者90例为研究对象,其中非透析患者（CKD5期组）60例,透析患者（CKD5D期组）30例.另选择30例健康体检者为对照组.收集所有入选者临床和常规实验室检查资料,测定T淋巴细胞亚群的比例,同时进行心脏超声检查.结果 （1）CKD5期组和CKD5D期组的超敏C-反应蛋白水平、CD＋4CDnull28T细胞比例均显著高于健康对照组（F=14.887、9.659,均P〈0.05）.（2）90例ESRD患者中,CKD5期组患者发生LVH的比例为76.67%,CKD5D期组患者发生LVH的比例为86.67%.（3）双变量相关分析显示,CKD5期组患者LVMI与高血压患病时间、收缩压、血磷、lg（CRP＋1）、lgiPTH、lg（CD＋4CDnull28＋1）呈正相关（r=0.332、0.291、0.269、0.310、0.304、0.396,均P〈0.05）,与Hb呈负相关（r=-0.285,P〈0.05）.多元线性回归分析,lg（CD＋4CDnull28＋1）、高血压患病时间是CKD5期组患者LVH的独立危险因素（F=6.589,P〈0.000）.结论 ESRD未透析患者和维持性透析患者普遍存在CRP水平升高和LVH以及CD＋4CDnull28T细胞的增加.与ESRD未透析患者LVH密切相关的因素有高血压、贫血、磷代谢紊乱、继发性甲状旁腺功能亢进、微炎症状态和CD＋4CDnull28T细胞.CD＋4CDnull28T细胞可能在ESRD未透析患者LVH中发挥作用.

Objective To determine CD＋4CDnull28 T cells and their relationship with the microinflammatory state and left ventricular hypertrophy in end-stage renal disease （ESRD） patients.Methods One hundred and twenty ESRD patients were selected,including sixty non-dialytic stage 5 chronic kidney disease patients（CKD5 stage） and thirty maintenance dialysis patients（CKD5D stage）.In addition,thirty healthy adults from the hospital medical center were selected as the control group.Flow cytometry was used to detect the frequencies of T lymphocyte subsets in peripheral blood.All enrolled subjects underwent Doppler echocardiography investigations.Results（1）Compared with the control group,the high sensitivity C-reactive protein and the frequency of CD＋4CDnull28 T cells were significantly expanded in CKD5 and CKD5D paients （F=14.887,9.659,all P〈0.05）.（2）In ninety ESRD patients,the incidence of LVH increased in CKD5 and CKD5D patients （76.67% vs.86.67%）.（3）Linear correlation in CKD5 patients showed that：LVMI was positively correlated to duration of hypertension,SBP,P3＋,lg（CRP＋1）,lgiPTH,lg（CD＋4CDnull28＋1） （r=0.332,0.291,0.269,0.310,0.304,0.396,all P〈0.05）,as well as negatively correlated to Hb（r=-0.285,P〈0.05）.Multiple linear regression analysis showed that LVMI was independently associated with lg（CD＋4CDnull28＋1） and duration of hypertension（F=6.589,P〈0.000）.ConclusionThere is microinflammatory state in the ESRD patients regardless of whether or not they have dialysis treatment,and they have the high incidence of LVH and exhibit a substantially increased frequency of circulating CD＋4CDnull28 T cells.The frequency of CD＋4CDnull28 T cells and duration of hypertension are the independent predictors of LVH in non-dialytic stage 5 CKD patients,indicates that these cells may play a critical role in the development of cardiovascular disease.