中国血液净化

›› 2007, Vol. 6 ›› Issue (3): 129-133.

• 论著 • 上一篇    下一篇

慢性肾衰竭患者血清sFas、sFasL水平变化及其与颈总动脉病变的相关性研究

李德谦1 梅长林2 张玉强2 王文靖2 李占园2   

  1. 1. 030006 太原，武警山西总队医院肾病科 2. 200003 上海，第二军医大学长征医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-03-12 发布日期:2007-03-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-03-12 Published:2007-03-12

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摘要： 目的 探讨尿毒症心血管疾病(CVD)患者血清可溶性Fas、FasL(sFas、sFasL)水平与相关因子和颈总动脉血管内膜-中层厚度(IMT)的相关性。方法 选择第二军医大学长征医院肾内科尿毒症血液透析(HD)伴CVD患者组103例,慢性肾病(CKD)[15＜GFR＜50ml/(min·1.73m2)]伴CVD未透析患者组30例,正常对照组30例入选。采用酶联免疫双抗体夹心法(ELISA)测定血清sFas、sFasL、C反应蛋白(CRP)、白蛋白浓度。免疫组化观察桡动脉血管内皮细胞的Fas、FasL表达；采用荧光逆转录－聚合酶链式反应(RT-PCR)测定Fas、FasL mRNA的含量；彩色超声波测量颈总动脉血管内膜－中层厚度(IMT)。 结果 HD、CKD组血清中可溶性FasL显著高于正常对照组(P＜0.01)，HD与CKD组水平差异无统计学意义，血清中可溶性Fas显著低于正常对照组(P＜0.01)。HD组血管壁Fas、FasL表达明显高于正常对照组。 荧光RT-PCR Fas、FasL mRNA定量分析HD组较正常对照组高50.00％。63.49％(40/63)HD组患者IMT增厚。双变量线性相关分析发现，sFasL与CRP及IMT均呈明显的正相关r=0.58,r=0.64)，P＜0.01；与白蛋白水平及肌酐清除率呈负相关(r =-0.53 r=-0.62)，P＜0.01；sFas则与之相反。 结论 血清sFasL水平及血管壁Fas、FasL高表达可能与动脉粥样硬化相关，其确切机制值得进一步研究。

关键词: sFas, sFasL, 尿毒症, 心血管疾病, 炎症

Abstract: Objective To investigate serum soluble Fas (sFas), soluble Fas ligand (sFasL)concentration and its correlation with known markers of inflammation, nutritional status and carotid arterial intima- media thickness(IMT) in uremic patients with cardiovascular disease. Methods One hundred and sixty-three subjects were enraolled in this study including 103 hemodialysis patients (HD group), 30 chronic kidney disease patients(CKD group, defined as 15＜GFR＜50ml/min/1.73m2) with and 30 healthy subjects as a control group. The serum level of sFas，sFasL, c-reactive protein (CRP) and albumin (ALB) were measured with enzyme-linked immunosorbent assay(ELISA). The expression of Fas and FasL on radial arterial endothelial cells were determined by immunohistochemical method and their mRNA expression were analyzed with reverse transcription-polymerase chain reaction(RT-PCR). The carotid arterial IMTs in uremic patients were evaluated using color doppler ultrasonography. Results Compared with control group, the level of serum sFasL in HD group and CKD group increased significantly, sFas decreased significantly，and the expression of Fas and FasL on radial arterial endothelial cells in HD group rose significantly too. In additon, Fluorescent RT-PCR showed expressions of Fas and FasL mRNA were 50.00% higher than that in control group. In HD group, 63.49% (40/63) patients presented increase of IMT. Bivariate correlation analysis showed sFasL was positively associationated with CRP and IMT (r = 0.58 and 0.64 respectively, P ＜0.01), but negatively correlationed with serum albumin and GFR (r=-0.53 and -0.62 respectively, P＜0.01), opposite for sFas. Conclusion Serum sFasL concentration increases extremely in uremic patients with CVD, so serum sFasL is likely to be a novel risk factor of cardiovascular disease in uremic patients.

Key words: Soluble Fas ligand, ? Uremia, Cardiovascular disease, Inflammation

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