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目的探讨慢性肾脏病(CKD)未透析患者五聚素3(PTX3)与血管内皮功能障碍的关系。方法选取2012年4月—2013年12月在首都医科大学附属北京朝阳医院肾内科住院或门诊治疗的符合纳入标准的CKD患者70例,采用简化MDRD公式计算估算肾小球滤过率(e GFR),并根据e GFR将患者分为CKD 1~3期组(A组,n=30)和CKD 4~5期组(B组,n=40)。另选取同期在首都医科大学附属北京朝阳医院体检中心体检健康者30例为对照组。采用ELISA法检测血清PTX3,采用外周动脉张力检测技术检测反应性充血指数(RHI)。收集3组一般资料[性别、年龄、糖尿病发生率、高血压发生率、吸烟率、收缩压(SBP)、舒张压(DBP)、脉压(PP)、平均动脉压(MAP)、体质指数(BMI)]、实验室检查指标[白细胞计数(WBC)、中性粒细胞分数(NE)、血红蛋白(HGB)、清蛋白(ALB)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿素氮(BUN)、血肌酐(Scr)、尿酸(UA)、血钙、血磷、全段甲状旁腺激素(PTH)]、炎性指标[超敏C反应蛋白(hs-CRP)、PTX3]、血管内皮功能指标(内皮素、RHI),并分析CKD患者PTX3与各指标的相关性。结果 A组SBP、MAP高于对照组(P<0.05);B组SBP、PP、MAP高于对照组、A组,DBP高于对照组(P<0.05)。A组NE、LDL-C、UA高于对照组,HGB、ALB低于对照组(P<0.05);B组NE、BUN、Scr、血磷、PTH高于对照组、A组,HGB、血钙低于对照组和A组,ALB低于对照组,LDL-C、UA高于对照组(P<0.05)。A组PTX3高于对照组,RHI低于对照组(P<0.05);B组hs-CRP、PTX3、内皮素高于对照组、A组,RHI低于对照组、A组(P<0.05)。Pearson相关性分析结果显示,PTX3与WBC(r=0.300,P=0.046)、NE(r=0.422,P=0.004)、Scr(r=0.320,P=0.032)、hs-CRP(r=0.342,P=0.022)、内皮素(r=0.307,P=0.036)呈正相关,与RHI(r=-0.374,P=0.011)呈负相关。结论 CKD患者PTX3与内皮素呈正相关,与RHI呈负相关。与hs-CRP相比,PTX3对于预测CKD患者血管内皮功能障碍可能是一个更好的指标。
Objective To investigate the relationship between pentaxin 3 (PTX3) and vascular endothelial dysfunction in patients with chronic kidney disease (CKD) without dialysis. Methods From April 2012 to December 2013, 70 eligible patients with CKD admitted to the Department of Nephrology, Beijing Chaoyang Hospital, Capital Medical University from April 2012 to December 2013 were enrolled in this study. The simplified GFRD formula was used to estimate the glomerular filtration rate (e GFR The patients were divided into three groups according to e GFR: stage 1 to stage 3 (group A, n = 30) and stage 4 to group 5 (group B, n = 40). In the same period, 30 healthy subjects in Beijing Chaoyang Hospital Medical Center affiliated to Capital Medical University were selected as the control group. Serum PTX3 was detected by ELISA, reactive hyperemia index (RHI) was measured by peripheral artery tension test. Three groups of general data were collected, including gender, age, incidence of diabetes, incidence of hypertension, smoking prevalence, SBP, DBP, MAP, MAP, BMI)], laboratory tests [WBC, NE, HGB, ALB, TC, triglyceride (TG), high density HDL-C, LDL-C, BUN, Scr, UA, serum calcium, serum phosphorus, total parathyroid hormone PTH)], inflammatory markers (hs-CRP, PTX3) and vascular endothelial function index (endothelin, RHI) were analyzed. The correlation between PTX3 and various indexes in CKD patients was analyzed. Results The SBP and MAP in group A were higher than those in control group (P <0.05). The SBP, PP and MAP in group B were higher than those in control group. The DBP in group A was higher than that in control group (P <0.05). The levels of NE, LDL-C and UA in group A were higher than those in control group, while the levels of HGB and ALB in control group were lower than those in control group (P <0.05); NE, BUN, Scr, Calcium was lower than the control group and A group, ALB was lower than the control group, LDL-C, UA higher than the control group (P <0.05). (P <0.05). The levels of hs-CRP, PTX3 and ET in group B were higher than those in control group, and the levels of RHI in group A were lower than those in control group and group A (P <0.05) . Pearson correlation analysis showed that there was significant difference between PTX3 and WBC (r = 0.300, P = 0.046), NE (r = 0.422, P = 0.004) P = 0.022) and endothelin (r = 0.307, P = 0.036), but negatively correlated with RHI (r = -0.374, P = 0.011) Conclusions PTX3 is positively correlated with endothelin in CKD patients and negatively correlated with RHI. Compared with hs-CRP, PTX3 may be a better predictor of vascular endothelial dysfunction in CKD patients.