CRP、IL-18在慢性肾脏病患者中的表达及与CKD-MBD进展的关系

Expression of CRP and IL-18 in patients with chronic kidney disease and its relationship with progression of CKD-MBD

目的研究微炎症状态标志物C反应蛋白(CRP)、白细胞介素(IL)-18在慢性肾脏病(CKD)患者中的表达及与慢性肾脏病-矿物质和骨异常(CKD-MBD)进展的关系。方法将该院2016年1月至2019年6月收治的113例CKD患者纳为研究对象,根据美国肾脏病基金会(NKF-K/DOQI)相关标准,将其分为CKD1~2期组(22例)、CKD3期组(46例)、CKD4期组(30例)及CKD5期组(15例)。统计各组患者CKD-MBD发生率,检测患者血清CRP、IL-18及血清钙(Ca)、磷(P)、甲状旁腺激素(PTH)水平,分析不同分期患者血清CRP、IL-18水平与Ca、P、PHT的相关性。结果113例CKD患者中共59例发生CKD-MBD(52.21%),CKD-MBD发生率在CKD1~2、CKD3、CKD4、CKD5期组间呈依次上升趋势。血清CRP、IL-18水平在CKD1~2、CKD3、CKD4、CKD5期组间呈依次上升趋势,组间差异有统计学意义(P<0.05)。CKD3、CKD4、CKD5期组Ca水平差异无统计学意义(P>0.05),但3组Ca水平均明显高于CKD1~2期组(P<0.05),血清P及PTH水平在CKD1~2、CKD3、CKD4、CKD5期组间均呈依次上升趋势,组间差异有统计学意义(P<0.05)。相关性分析提示,CKD5期组患者血清CRP、IL-18水平与血清Ca呈负相关(r=-0.372、-0.369,P<0.05),与血清P及PTH呈正相关(r=0.421、0.253,0.433、0.272;P<0.05)。结论CKD患者CKD-MBD发生率较高,其微炎症状态与CKD-MBD密切相关,两者可能通过相互作用促进CKD发展。

Objective To investigate the expression of microinflammatory state marker C-reactive protein(CRP)and interleukin-18(IL-18)in the patients with chronic kidney disease(CKD)and its relationship with the progression of chronic kidney disease-mineral and bone disorder(CKD-MBD).Methods One hundred and thirteen cases of CKD treated in this hospital from January 2016 to June 2019 were included as the study subjects and divided into four groups according to the standards of National Kidney Foundation(NKF)Kidney Disease Outcome Quality Initiative(K/DOQI),CKD stage 1-2 group(22 cases),CKD stage 3 group(46 cases),CKD stage 4 group(30 cases)and CKD stage 5 group(15 cases).The incidence rates of CKD-MBD in various groups conducted the statistics.The levels of serum CRP,IL-18,calcium(Ca),phosphorus(P)and parathyroid hormone(PTH)were measured,and the levels of serum CRP and IL-18 in each stage and their correlation with Ca and P were analyzed.Results Among 113 cases of CKD,59 cases(52.21%)developed CKD-MBD,the occurrence rate of CKD-MBD showed the increasing trend in the CKD stage 1-2 group,CKD stage 3 group,CKD stage 4 group and CKD stage 5 group.The levels of serum CRP and IL-18 showed the increasing trend in turn in the CKD stage 1-2 group,CKD stage 3 group,CKD stage 4 group and CKD stage 5 group,and the inter-group differences had statistical significance(P<0.05).The Ca level had no statistical difference among the CKD stage 3 group,CKD stage 4 group and CKD stage 5 group(P>0.05),but the Ca level in these 3 groups was significantly higher than that in the CKD stage 1-2 group(P<0.05).The serum P and PTH levels in the CKD stage 1-2 group,CKD stage 3 group,CKD stage 4 group and CKD stage 5 group showed the increasing trend in turn,and the inter-group differences had statistical significance(P<0.05).The correlation analysis indicated that serum CRP and IL-18 levels in the CKD stage 5 group were negatively correlated with serum Ca level(r=-0.372,-0.369,P<0.05),and positively correlated with serum P and PTH levels(r=0.421,0.253,0.443,0.272;P<0.05).Conclusion The incidence rate of CKD-MBD in the patients with CKD is high,the microinflammatory state is closely correlated with CKD-MBD,and the both may promote the CKD progress by mutual interaction.