中国血液净化

›› 2007, Vol. 6 ›› Issue (4): 180-183.

• 论著 • 上一篇    下一篇

炎症因子对维持性血液透析患者左心室重塑的影响

邬碧波 唐 琦 张黎明 贺云岚 郝晓萍   

  1. 200070 上海，上海市闸北区中心医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-04-12 发布日期:2007-04-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-04-12 Published:2007-04-12

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摘要： 目的 通过观察白介素-1β(IL-1β)、白介素-6（IL-6）、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)对维持性血液透析(MHD)患者心脏结构和功能相关指标的影响，探讨炎症因子对MHD患者左心室重塑的作用。方法 选择上海市闸北区中心医院肾内科血液净化中心透析龄超过3个月的MHD患者64例，病情稳定，已排除急性感染及其他活动性疾病，分别检测患者的各种炎症因子、并应用心脏超声心动图测定患者的左房内径(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)等、计算左心室心肌重量指数(LVMI)，分析MHD患者炎症因子对左心室重塑的影响。结果 MHD患者血清CRP、TNF-帷L-1β、IL-6、IL-8水平均显著高于正常对照组，二者差异有显著性(P＜0.05，P＜0.01)；MHD患者LAD、LVDd、IVST、LVPWT值均明显高于正常对照组，二者差异有显著性 (P ＜0.05，P＜0.01）， LVEF值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)，有统计学意义；CRP、IL-1β、IL-6、TNF-α分别与LAD、LVDd、IVST、LVPWT、LVMI呈正相关(P＜0.05，P＜0.01），与LVEF呈负相关(P＜0.05)；CRP分别与IL-1β、IL-6、TNF-α相互之间呈正相关 (P＜0.05，P＜0.01）； TNF-α、IL-1β、IL-6相互之间呈正相关(P＜0.05)。结论 MHD患者存在微炎症状态，并且可能参与了左心室重塑的发生和发展。

关键词: C反应蛋白, 白细胞介素, 肿瘤坏死因子, 心室重塑, 血液透析

Abstract: Objective To investigate the effects of interleukin 1β (IL-1β), interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor- (TNF-) and C-reactive protein (CRP) on left ventricular remodeling in patients with maintenance hemodialysis. Methods Sixty-four patients with maintenance hemodialysis were selected, who had undergone hemodialysis for more than three months and were in a stable clinic status without signs of acute infections or other progressive diseases. Serum IL-1β, IL-6, IL-8 and TNF- were measured by enzyme-linked immunosorbent assay (ELISA). The left atrial diameter (LAD), left ventricular end-diastolic diameter (LVDd), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT) and left ventricular ejection fraction (LVEF) were measured by ultrasonic cardiography. Results The average serum IL-1β, IL-6, IL-8, TNF- and CRP were significantly higher in patients than those in the normal control group (P＜0.05 or P＜0.01). LAD, LVDd, IVST, LVPWT and left ventricular mass index (LVMI) increased significantly (P＜0.05 or P＜0.01), while LVEF decreased markedly (P＜0.05). In patients with maintenance hemodialysis, the average serum IL-1β, IL-6, TNF- and CRP were positively correlated with the values of LVDd, LAD, LVPWT, IVST and LVMI (P＜0.05 or P＜0.01), but negatively correlated with the value of LVEF (P＜0.05). The mean level of CRP was positively correlated with the levels of IL-1β, IL-6 and TNF- (P＜0.05 or P＜0.01), and the mean level of TNF- was positively correlated with the levels of IL-1β and IL-6 (P＜0.05). Conclusion The inflammatory factors are probably involved in the presence and progression of left ventricular remodeling in patients with maintenance hemodialysis.

Key words: Interleukin, Tumor necrosis factor, Ventricular remodeling, Hemodialysis

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