中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (01): 17-22.doi: 10.3969/j.issn.1671-4091.2014.1.005

• 临床研究 • 上一篇    下一篇

维持性血液透析患者颈动脉内中膜厚度与血清高敏C反应蛋白、成纤维细胞生长因子23和klotho蛋白的相关性研究

孙颖1,陈爱群1,王川予2,李超群2,毛永辉1,吴华1   

  1. 1. 卫生部北京医院 肾内科
    2. 卫生部北京医院 超声科
  • 收稿日期:2013-07-30 修回日期:2013-10-10 出版日期:2014-01-12 发布日期:2014-01-12
  • 通讯作者: 吴华 wuhua@medmail.com.cn E-mail:wuhua@medmail.com.cn
  • 基金资助:

    国家自然科学基金项目：81200523

Study on correlation between carotid intima-media thickness with serum HsCRP, FGF23 and Klotho protein in maintenance hemodialysis patients

  • Received:2013-07-30 Revised:2013-10-10 Online:2014-01-12 Published:2014-01-12

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摘要： 目的 了解维持性血液透析（MHD）患者颈动脉粥样硬化情况，分析该人群颈动脉内中膜厚度（CIMT）与血清高敏C反应蛋白（HsCRP）、成纤维细胞因子23（FGF23）及Klotho蛋白水平与之间的相关性。方法 选取2012年1月至2012年6月期间在卫生部北京医院血液净化中心MHD患者共88例，根据颈动脉彩色多普勒超声检查结果分为CIMT增厚组和CIMT正常组。采用酶联免疫吸附（ELISA）双抗体夹心法测定FGF23和Klotho蛋白。对CIMT增厚可能的危险因素：年龄、透析龄、性别、糖尿病、合并用药、FGF23、Klotho蛋白、HsCRP、血脂等进行分析，比较组间差异，采用非条件Logistic回归分析进行CIMT影响因素的多因素分析。结果 88例MHD患者中CIMT增厚患者共53例，占60.2%，CIMT正常患者共35例，占39.8%，两组CIMT中位数分别为1.5mm和1.0mm，差别有显著统计学意义（P=0.000）。其中CIMT增厚组粥样硬化斑块发生率明显高于CIMT正常组（92.5% vs.65.7%，P=0.001）。单因素分析中，CIMT增厚组平均年龄为66.64±10.61岁，CIMT正常组平均年龄为58.63±11.78岁，差别有统计学意义（t=3.320，P=0.001）；CIMT增厚组糖尿病患病率为37.7%，CIMT正常组糖尿病患病率为17.1%，差别有统计学意义（ =4.294，P=0.038）； CIMT增厚组与正常组FGF23中位数分别为127.82 ng/L和86.74 ng/L，差别有显著统计学意义（Z=-3.713，P=0.000）；两组HsCRP中位数分别为5.34mg/L和2.19mg/L，差别有显著统计学意义（Z=-3.547，P=0.000）。CIMT增厚组与CIMT正常组Klotho蛋白中位数分别为42.48 U/L和41.21 U/L，两组无显著差别（Z=-0.085，P=0.932）。非条件Logistic回归分析显示年龄、FGF23和HsCRP是CIMT增厚的独立危险因素，OR值分别为1.061（1.007,1.118）、1.016（1.003,1.028）和1.344（1.115,1.621）。结论 MHD患者伴CIMT增厚者易形成动脉粥样硬化斑块。血清HsCRP、FGF23和年龄是MHD患者CIMT增厚的独立危险因素。

关键词: 维持性血液透析, 颈动脉内中膜厚度, 高敏C反应蛋白, 成纤维细胞因子23, Klotho蛋白

Abstract: OBJECTIVE To understand the clinic feature of the maintenance hemodialysis(MHD) patients with carotid artery atherosclerosis, analyze the relationship between carotid intima-media thickness(CIMT) and serum high sensitive c-reactive protein(HsCRP)， fibroblast growth factor 23(FGF23), Klotho protein levels. METHODS 88 MHD patients were enrolled in the blood purification center, Beijing Hospital of the Ministry of Health, from January to June 2012. The patients were divided into CIMT thickening group and the CIMT normal group based on their carotid color Doppler ultrasound results. FGF23 and Klotho protein were detected by using double antibody sandwich enzyme-linked immunosorbent assay (ELISA). Possible risk factors of CIMT thickening, such as age, gender, duration of dialysis, diabetes, combination therapy, FGF23, Klotho protein, hsCRP, lipids were analyzed and compared between the two groups, while non-conditional logistic regression were used for multivariate analysis to determine the risk factors for CIMT thickening. RESULTS Among the 88 MHD patients, increased CIMT was found in 53 patients（60.2%）, while the remaining 35 patients (39.8%) had normal CIMT. The median of the two sets of CIMT were 1.5mm and 1.0mm respectively, and the difference between the two groups was statistically significant（P=0.000）. The incidence of atherosclerotic plaque in the group with increased CIMT was significantly higher than the group with normal CIMT（92.5% vs.65.7%，P=0.001）. Univariate analysis indicated that the average age of the CIMT thickened group was 66.64±10.61 years, and the average age of the group with normal CIMT was 58.63±11.78 years, the difference was statistically significant（t=3.320，P=0.001）; Diabetes prevalence of the CIMT thickened group was 37.7%, Diabetes prevalence of the group with normal CIMT was 17.1%, the difference was statistically significant（ =4.294，P=0.038）; The median of the two sets of FGF23 were 127.82 ng/L and 86.74 ng/L respectively, the difference was statistically significant（Z=-3.713，P=0.000）; The median of the two sets of HsCRP were 5.34mg/L and 2.19mg/L respectively, the difference was statistically significant（Z=-3.547，P=0.000）; The median of the two sets of Klotho protein were 42.48 U/L and 41.21 U/L respectively, the difference was not statistically significant（Z=-0.085，P=0.932）. Non-conditional logistic regression analysis showed that age, FGF23 and hsCRP were independent risk factors for CIMT thickening in MHD patients, OR values were 1.061 (1.007,1.118), 1.016 (1.003,1.028), 1.344 (1.115,1.621), respectively. CONCLUSION Thickened CIMT are prone to have more atherosclerosis plaque with MHD patients . Serum HsCRP, FGF23 and age are independent risk factors for CIMT thickening in MHD patients.

Key words: Maintenance Hemodialysis, Carotid Intima-media Thickness, High Sensitive C-reactive Protein, Fibroblast Growth Factor 23, Klotho Protein.