维持性血液透析患者炎症与颈动脉粥样硬化的关系

The Inflammation Association with Carotid Atherosclerosis in Hemodialysis Patients

研究维持性血液透析患者慢性炎症状态与颈动脉粥样硬化的关系 ,选择维持性血液透析患者 2 5例和健康对照者 15例 ,用酶联免疫吸附法检测高敏C反应蛋白和肿瘤坏死因子α来评价慢性炎症状态 ,用高分辨超声技术检测颈总动脉内膜中膜厚度和粥样硬化斑块来评价动脉粥样硬化程度。结果发现 ,维持性血液透析患者血浆高敏C反应蛋白和肿瘤坏死因子α水平均明显高于正常对照组 ,维持性血液透析患者颈总动脉内膜中膜厚度和斑块检出率明显高于年龄、性别匹配的正常对照组。维持性血液透析患者血浆肿瘤坏死因子α水平 (取对数值 )与平均颈总动脉内膜中膜厚度呈显著正相关 (r=0 .792 ,P <0 .0 0 1)。多因素逐步回归分析结果表明 ,影响颈总动脉内膜中膜厚度的因素有血浆肿瘤坏死因子α水平 (对数转化 )、年龄、高密度脂蛋白胆固醇、C反应蛋白、磷、载脂蛋白B、前白蛋白和甘油三酯。结果提示 ,维持性血液透析患者存在慢性炎症状态 ,炎症在动脉粥样硬化的发病机制中起重要的作用。

Aim To determine whether chronic inflammatory status is associated with carotid atherosclerosis in maintenance hemodialysis (MHD)patients. Methods Twenty-five MHD patients and fifteen healthy volunteers were included in this study. The levels of high-sensitive C-reactive protein (hs-CRP) and tumor necrotic factor-α (TNF-α) were used to assess the chronic inflammatory status measured by ELISA. Intima-media thickness (IMT) and prevalence of atherosclerotic plaques of the extracranial common carotid artery were measured by high-resolution B mode ultrasonography. Results The levels of plasma hs-CRP and TNF-α in the MHD patients were higher than those in the healthy volunteers. The prevalence of atherosclerotic plaques and the mean IMT value of carotid artery significantly increased in MHD patients compared with those in age and sex-matched controls. Age and the levels of plasma transformed TNF-α were positively correlated to CCA-IMT (r=0.733,P<0.001;r=0.792,P<0.001) respectively. Multiple stepwise regression analysis showed that in MHD patients, the independent risk factors associated with value of IMT were plasma transformed TNF-α levels, age, high density lipoprotein cholesterol (HDLC), CRP, phosphorus, apolipoprotein B, prior albumin and triglyceride. Conclusion Chronic inflammatory status is really present in MHD patients; inflammation plays a role in the pathogenesis of atherosclerosis in these patients.