慢性肾脏病合并心血管疾病患者血液透析治疗对微炎症因子及血管钙化的影响

Effects of hemodialysis on microinflammatory factors and vascular calcification in patients with chronic kidney disease and cardiovascular disease

目的研究血液透析治疗对慢性肾脏病合并心血管疾病患者微炎症因子及血管钙化的影响。方法选取广东医科大学附属第三医院肾内科2018年2月至2020年2月期间收治的60例维持性血液透析合并心血管疾病患者作为观察组,另选取60例未合并心血管疾病的同期维持性血液透析患者作为对照组。记录并比较两组患者的白细胞、血色素、体质量指数(BMI)、收缩压、舒张压、血清微炎症因子[C反应蛋白(CRP)、瘦素(Leptin)]和钙化指标[血β_(2)-微球蛋白(血β_(2)-M)、甲状旁腺激素(PTH)、电解质(血钾、血钙、血磷)、血红蛋白(Hb)]水平,以及钙化积分及钙化发生情况。结果观察组患者的血清CRP、Leptin水平分别为(33.2±12.6)mg/L、(29.4±12.7)μg/L,明显高于对照组的(23.7±11.3)mg/L、(21.5±11.1)μg/L,差异均有统计学意义(P<0.05);观察组患者血β_(2)-M、PTH、血钾、血钙、血磷分别为(2.64±1.03)μg/mL、(47.2±11.5)ng/L、(4.12±0.43)mmol/L、(2.16±0.21)mmol/L、(1.14±0.13)mmol/L,明显低于对照组的(6.85±2.16)μg/mL、(105.5±17.3)ng/L、(4.76±0.69)mmol/L、(2.54±0.35)mmol/L、(1.76±0.32)mmol/L,Hb水平为(101.5±18.4)g/L,明显高于对照组的(83.8±14.1)g/L,差异均有统计学意义(P<0.05);观察组患者的钙化发生率和钙化积分分别为96.7%、(4.6±1.5)分,明显高于对照组的68.3%、(2.7±0.9)分,差异均有统计学意义(P<0.05)。结论慢性肾脏病合并心血管疾病患者具有较高的微炎症因子水平,血管钙化发生率明显升高,可作为维持性血液透析患者心血管疾病发生的预警指标,具有临床指导意义。

Objective To study the effect of hemodialysis on microinflammatory factors and vascular calcifica-tion in patients with chronic kidney disease and cardiovascular disease.Methods Sixty patients with chronic kidney disease complicating cardiovascular disease undergoing maintenance hemodialysis admitted to the Department of Ne-phrology,the Third Affiliated Hospital of Guangdong Medical University from February 2018 to February 2020 were se-lected as the observation group,and another 60 patients undergoing maintenance hemodialysis without cardiovascular disease during the same period were selected as the control group.The white blood cells,hemoglobin,body mass index(BMI),systolic pressure,diastolic blood pressure,serum inflammatory markers(C-reactive protein[CRP],Leptin[Leptin]),and calcification indexes(blood beta 2-microglobulin[bloodβ_(2)-M],parathyroid hormone[PTH],electrolyte[blood potassium,calcium,phosphorus],hemoglobin[Hb])were recorded and compared,as well as calcification score and calcification incidence.Results The serum levels of CRP and Leptin in the observation group were(33.2±12.6)mg/L and(29.4±12.7)μg/L,which were significantly higher than(23.7±11.3)mg/L and(21.5±11.1)μg/L in the control group(P<0.05);the indexes of bloodβ_(2)-M,PTH,serum potassium,serum calcium,and serum phosphorus in the observation group were(2.64±1.03)μg/mL,(47.2±11.5)ng/L,(4.12±0.43)mmol/L,(2.16±0.21)mmol/L,(1.14±0.13)mmol/L,which were significantly lower than(6.85±2.16)μg/mL,(105.5±17.3)ng/L,(4.76±0.69)mmol/L,(2.54±0.35)mmol/L,(1.76±0.32)mmol/L in the control group,and the level of Hb was(101.5±18.4)g/L,which was significantly higher than(83.8±14.1)g/L in the control group,with statistically significant differences(P<0.05);the calcification incidence and calcification score in the observation group were 96.7%and(4.6±1.5)points,which were significantly higher than 68.3%and(2.7±0.9)points in the control group(P<0.05).Conclusion Patients with chronic kidney disease combined with cardiovascular disease have higher levels of microinflammatory factors and significantly increased incidence of vas-cular calcification,which can be used as an early warning indicator for the occurrence of cardiovascular disease in pa-tients undergoing maintenance hemodialysis and has clinical guiding significance.