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目的比较慢性肾病(CKD)患者与健康对照组血浆中内皮细胞微颗粒(EMPs)、血管性血友病因子(vWF)水平的变化,探讨EMPs在CKD中的意义。方法采用流式细胞术及酶联免疫吸附试验(ELISA法)检测72例CKD患者和20名健康对照者血浆中EMPs、vWF的水平,并分析EMPs水平与血压、肌酐清除率、24h尿蛋白定量、血红蛋白、胆固醇之间的关系。结果CKD组患者血浆EMPs和vWF水平较健康对照组均显著增高;肾病综合征组EMPs的水平明显高于高血压肾病组,肾病综合征组vWF的水平明显高于高血压肾病组及慢性肾炎组,以上差异均有统计学意义(P<0.05或P<0.01)。CKD分期中Ⅰ期血浆中EMPs含量明显高于Ⅳ期,差异有统计学意义(P<0.05);其余各期间EMPs和vWF水平的差异均无统计学意义(P>0.05)。EMPs的水平与血压成正相关(P<0.05),与肌酐清除率、24h尿蛋白定量、血红蛋白、胆固醇均无明显相关性(P>0.05)。vWF与EMPs成正相关(P<0.05)。结论CKD患者存在内皮功能障碍,高血压是使内皮功能异常的重要原因之一,EMPs可作为一种反映内皮功能的新标记。
Objective To compare the changes of plasma endotheliocyte micro-particles (EMPs) and von Willebrand factor (vWF) in patients with chronic kidney disease (CKD) and healthy controls, and to explore the significance of EMPs in CKD. Methods The plasma levels of EMPs and vWF were measured by flow cytometry and enzyme-linked immunosorbent assay (ELISA) in 72 patients with CKD and 20 healthy controls. The levels of EMPs and blood pressure, creatinine clearance, 24-hour urinary protein , Hemoglobin, cholesterol, the relationship between. Results The levels of plasma EMPs and vWF in CKD group were significantly higher than those in healthy controls. The levels of EMPs in nephrotic syndrome group were significantly higher than those in hypertensive nephropathy group. The levels of vWF in nephrotic syndrome group were significantly higher than those in hypertensive nephropathy group and chronic nephritis group , The above differences were statistically significant (P <0.05 or P <0.01). The level of EMPs in stage Ⅰ plasma was significantly higher than that in stage Ⅳ in CKD stage (P <0.05). There was no significant difference in the levels of EMPs and vWF in other stages (P> 0.05). The levels of EMPs were positively correlated with blood pressure (P <0.05), and had no significant correlation with creatinine clearance, 24h urinary protein, hemoglobin and cholesterol (P> 0.05). There was a positive correlation between vWF and EMPs (P <0.05). Conclusions Endothelial dysfunction exists in patients with CKD. Hypertension is one of the major causes of endothelial dysfunction. EMPs may serve as a new marker of endothelial function.