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目的:探讨维持性血液透析患者(MHD)血中C反应蛋白(CRP)、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、血清白蛋白(Alb)与其心脏结构和功能指标之间关系,MHD患者微炎症状态相关因子与左心室重塑的关系。方法:随机选择老年MHD患者30例、中年MHD患者30例、健康人(对照组)28例,分别检测CRP、IL-1、IL-6、IL-10、TNF-α、Alb水平,并应用超声心动图测定他们的左房内径(LAD)、左心室舒张末内径(LVDd)、左心室收缩末内径(LVDs)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室射血分数(LVEF)、计算左心室心肌重量指数(LVMI),胸部平片计算心胸比率。分析炎症与左心关系。结果:MHD患者中CRP、IL-1、IL-6、IL-10、TNF-α等指标明显高于对照组,三者差异有统计学意义(P<0.05);MHD患者LAD、LVDd、LVDs、IVST、LVWPT值均明显高于对照组,三者差异有统计学意义(P<0.05);Alb、LVEF较正常对照组明显降低(P<0.05);LVMI较正常对照组显著升高(P<0.01)。CRP、IL-1、IL-6、TNF-α分别与LAD、LVDs、LVD、IVST、LVWPT、LVMI呈正相关(P<0.05),与LVEF呈负相关(P<0.05);IL-10分别与LAD、LVDs、LVDd、IVST、LVWPT、LVMI呈负相关(P<0.05),与LVEF呈正相关(P<0.05)。老年MHD组LAD、LVPWT、IVST、LVMI水平显著高于中年组(P<0.05),而LVEF显著低于中年组(P<0.05)。结论:MHD患者存在微炎症状态,与心室重塑的发生和发展有关,老年MHD患者尤为显著。
Objective: To investigate the changes of blood levels of C-reactive protein (CRP), interleukin-1 (IL-1), interleukin-6 (IL-6) and interleukin-10 (IL-6) in maintenance hemodialysis patients (MHD) 10), tumor necrosis factor-α (TNF-α), serum albumin (Alb) and its cardiac structure and function, and the relationship between microinflammatory state-related factors and left ventricular remodeling in patients with MHD. Methods: Thirty patients with senile MHD, 30 middle-aged MHD and 28 healthy controls were enrolled. The levels of CRP, IL-1, IL-6, IL-10, TNF- Their left atrium (LAD), left ventricular end diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), thickness of interventricular septum (IVST), left ventricular posterior wall thickness (LVPWT) LVEF, left ventricular mass index (LVMI), thoracic radiographs to calculate cardiothoracic ratio. Analysis of inflammation and left heart relationship. Results: The levels of CRP, IL-1, IL-6, IL-10 and TNF-α in MHD patients were significantly higher than those in control group (P <0.05) (P <0.05); Alb and LVEF were significantly lower than those in normal control group (P <0.05); LVMI was significantly higher than that in control group (P <0.05) <0.01). The levels of CRP, IL-1, IL-6 and TNF-α were positively correlated with LAD, LVDs, LVD, IVST, LVWPT and LVMI (P < LVE, LVDs, LVDd, IVST, LVWPT and LVMI (P <0.05), and positively correlated with LVEF (P <0.05). The levels of LAD, LVPWT, IVST and LVMI in elderly MHD group were significantly higher than those in middle age group (P <0.05), but LVEF was significantly lower than that in middle age group (P <0.05). Conclusion: The micro-inflammatory status of patients with MHD is related to the occurrence and development of ventricular remodeling, especially in elderly MHD patients.