COMM域蛋白5参与血液透析患者甲状旁腺切除术后血压下降的机制

Mechanisms of COMMD5 participates in hypotensive effect after parathyroidectomy in hemodialysis patients

目的:探讨血液透析(HD)甲状旁腺切除术(PTx)患者COMM域蛋白5(COMMD5)与血压下降之间的关系。方法:用ELISA方法检测HD患者PTx前后COMMD5水平,并在体外使用COMMD5重组蛋白刺激大鼠血管内皮细胞,观察心房利钠肽(ANP)和内皮型一氧化氮合酶(eNOS)等血管活性物质的表达情况。结果:(1)HD患者PTx术后血压低于术前(收缩压140.58±20.55 mmHg vs 148.81±18.14 mmHg,P<0.05;舒张压75.48±12.83 mmHg vs 88.74±10.92 mmHg,P<0.000 1);(2) PTx术后血液COMMD5较术前升高[0.97(0.64~1.79)ng/mL vs 0.65(0.43~1.07) ng/mL,P=0.02]。(3)PTx术前后收缩压下降与COMMD5相关,r=-0.57;P=0.000 7;舒张压下降与COMMD5相关,r=-0.36;P=0.043 6;(4)体外COMMD5重组蛋白刺激血管内皮细胞24h,ANP蛋白的表达量是空白对照组的2.39倍(P=0.017 9);eNOS蛋白的表达量是空白对照组的2.70倍(P=0.000 5)。结论:HD患者PTx后血清COMMD5水平升高,可能通过COMMD5上调ANP、eNOS表达,参与PTx后血压下降。

Objective:To evaluat the ecorrelation between decrease of blood pressure and concentrations of COMM domain-containing protein 5(COMMD5)in hemodialysis patients after parathyroidectomy(PTx).Methodology:(1)Blood pressure and COMMD5 serum concentrations were measured before and after PTx.(2)Rat vascular endothelial cells were stimulated with COMMD5 recombinant protein,and protein of ANP and eNOS were detected by Western blot.Results:(1)Post-PTx blood pressure(BP)was lower than pre-PTx level(Systolic BP 140.58±20.55 mmHg vs 148.81±18.14 mmHg,P<0.05;Diastolic BP 75.48±12.83 mmHg vs 88.74±10.92 mmHg,P<0.0001)(2)Post-PTx serum COMMD5 concentration was higher than pre-PTx[0.97(0.64-1.79)ng/ml vs 0.65(0.43-1.07)ng/ml,P=0.02].(3)There was a correlation between the decreases in systolic BP and plasma COMMD5;r=-0.57,P=0.0007;the decreases diastolic BP was associated with plasma COMMD5,r=-0.36,P=0.0436.(4)In vitro,COMMD5 recombinant protein stimulated vascular endothelial cells for 24 hours,the expression of ANP protein was 2.39 times that of Control group,P=0.0179;the expression of eNOS protein was 2.70 times that of Control group,P=0.0005.Conclusion:Serum COMMD5 level increased after PTx in HD patients,and COMMD5 up-regulated expression of ANP and eNOS,which may participated in hypotension after PTx in these patients.