维持性血液透析尿毒症患者外周血MCP-1、TNF-α、IL-6和hs-CRP水平对血管通路功能的影响

Effects of MCP-1,TNF-α,IL-6 and Hs-CRP Levels in Peripheral Blood on Function of Vascular Access in Treatment of Patients with Maintenance Hemodialysis

目的探讨维持性血液透析尿毒症患者外周血单核细胞趋化蛋白1(MCP-1)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和超敏C反应蛋白(hs-CRP)水平对血管通路功能的影响。方法选取行维持性血液透析的尿毒症53例作为研究对象,根据不同血管通路情况分为3组,首次行动静脉内瘘术行血液透析治疗者为A组17例,血液透析治疗中血管通路功能正常者为B组20例,血液透析治疗中血管通路功能失常者为C组16例,观察比较3组炎性指标及A、C组血管病理检查指标,并对血hs-CPR水平与年龄、血液透析时间及血管病理检查指标相关性进行分析。结果 3组血TNF-α、IL-6及hs-CRP水平总体比较差异均有统计学意义(P<0.05)。C组血TNF-α、IL-6及hsCRP水平均明显高于A组和B组,差异具有统计学意义(P<0.05)。C组桡动脉内膜厚度大于A组,CD68及MCP-1在桡动脉壁上的表达高于A组,差异具有统计学意义(P<0.05)。相关性分析显示,维持性血液透析尿毒症患者血hs-CRP水平与年龄、血液透析时间、桡动脉内膜厚度及MCP-1、CD68在桡动脉壁上的表达均呈正相关。结论炎症反应是导致维持性血液透析尿毒症患者血管通路功能丧失的原因之一。维持性血液透析尿毒症患者外周血MCP-1、TNF-α、IL-6和hs-CRP水平对保持血管通路功能稳定至关重要。

Objective To investigate effects of monocyte chemotactic protein-1( MCP-1),tumor necrosis factor-α( TNF-α),interleukin-6( IL-6) and hypersensitive c-reactive protein( hs-CRP) levels in peripheral blood on function of vascular access in patients with maintenance hemodialysis uremia. Methods A total of 53 patients with uremic maintenance hemodialysis were divided into 3 groups according to different vascular accesses. Patients who underwent hemodialysis treatment after the first time of internal arteriovenous fistula operation were used as group A( n = 17); patients who had normal vascular access during hemodialysis treatment were used as group B( n = 20); patients who had abnormal vascular access during hemodialysis treatment were used as group C( n = 16). Inflammation indexes among three groups and pathological indexes in group A and C were observed and compared,and correlations between hs-CPR level with age,hemodialysis time and pathological indexes were also analyzed. Results There were significant differences in TNF-α,IL-6 and hs-CRP among three groups( P < 0. 05). TNF-α,IL-6 and hs-CRP levels in group C were significantly higher than those in group A and B( P < 0. 05). In group C,intima thickness value of radial artery was larger,and CD68 and MCP-1 expressions on radial artery wall were significantly higher than those in group A( P < 0. 05). Correlation analysis showed that hs-CRP levels were positively correlated with age,hemodialysis time,intima thickness of radial artery and expressions of MCP-1 and CD68 on radial artery wall in patients with maintenance hemodialysis uremia. Conclusion Inflammatory reaction is one of the reasons leading to loss of vascular access function in patients with maintenance hemodialysis uremia. MCP-1,TNF-α,IL-6 and hs-CRP levels in peripheral blood of patients with maintenance hemodialysis uremia are very important in maintaining the stable function of vascular access.