中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (06): 297-300.doi: 10.3969/j.issn.1671-4091.2013.06.00

• 临床研究 • 上一篇    下一篇

腹膜透析患者颈动脉内膜中层厚度变异性与CRP水平及腹膜转运特性间的关系

刘桂凌,郝丽,王道洋,李丹丹,江冬瑞,解翔   

  1. 安徽医科大学第二附属医院
  • 收稿日期:2013-01-04 修回日期:2013-04-24 出版日期:2013-06-12 发布日期:2013-07-01
  • 通讯作者: 刘桂凌 E-mail:fulichang369@126.com

Study the relationship between high-sensitivity C-reactive protein level and intima-media thickness variability on different peritoneal permeability of the maintenance peritoneal dialysis patients

  • Received:2013-01-04 Revised:2013-04-24 Online:2013-06-12 Published:2013-07-01

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摘要： 目的：探讨维持性腹膜透析（maintenance peritoneal dialysis， MPD）患者的腹膜转运特性与体内超敏C反应蛋白（High-sensitivity C-reactive protein ，Hs-CRP）及颈动脉(carotid)内膜-中层厚度变异性（intima-media thickness variability, IMTV）间的关系。方法：选取随访的维持性腹膜透析6个月以上的患者56例，排除了腹膜炎症、肿瘤、原发性高血压、近3月服用他汀类药物的患者，通过PET将患者分为高通透性组（D/P＞0.65）和低通透性组（D/P≤0.65）组。根据PET结果制定PD处方，使每周肌酐清除率CCr＞50L/W.1.73m2，KT/V≥1.7。同时测定患者超敏C-反应蛋白（Hs-CRP）、血肌酐（Scr）、总胆固醇（TCH）、高密度脂蛋白(HDL)及血压。并予以颈动脉内膜血管彩超检查，测定颈动脉内膜-中层厚度（intima-media thickness variability ,IMT）。6个月后，再次测定上述血清指标及行超声检查，血检指标取两次检测结果的平均值，并根据超声检查结果计算6个月前后颈动脉内膜-中层厚度的变异性（IMTV），分析不同腹膜转运特性患者体内Hs-CRP水平、Scr、血压、TCH、HDL、IMT、IMTV间的差异性，并分析影响IMTV的因素。P＜0.05说明差异有统计学意义。结果：①MPD高通透性组患者的Hs-CRP水平、平均动脉压（MAP）、IMTV等明显高于低通透性组（P＜0.05），HDL水平明显低于低通透性组（P＜0.05），而IMT无明显差异（P＞0.05）。②Pearson相关分析发现，患者体内IMTV与Hs-CRP水平、MAP、腹膜的通透性（D/P值）等呈正相关，与HDL呈负相关，与SBP、DBP、TCH无关。③多因素回归分析发现，影响IMTV的独立危险因素有Hs-CRP水平、D/P值。结论：①高通透性组的微炎症状态重于低通透性组，微炎症状态和腹膜转运特性是影响MPD患者颈动脉内膜-中层厚度变异性的主要因素。②控制PD患者尤其是腹膜高转运状态PD患者体内的微炎症水平是降低颈动脉内膜-中层厚度变异性、延缓动脉硬化、减少MPD患者心血管事件并发症的重要手段。

关键词: 腹膜转运特性, C反应蛋白, 颈动脉内膜中层厚度, 变异性

Abstract: Objective :To study the relationship between high-sensitivity C-reactive protein level and intima-media thickness variability on different peritoneal permeability of the maintenance peritoneal dialysis patients．Methods: Selected 56 patients followed-up more than 6 months in our peritoneal dialysis center, exclude peritonitis, cancer, primary hypertension and taking statins of last 3 month. According to the peritoneal equilibration test(PET), the observed object were divided into high permeability group（D/P＞0.65）and low permeability group（D/P≤0.65）.And according to the PET, development of dialysis prescription, so that to achieve weekly clearance rate of the creatinine (Ccr)> 50L/W.1.73m2 and urea clearance index of KT/ V ≥ 1.7。Simultaneous determination of high-sensitivity C-reactive protein (Hs-CRP), serum creatinine (Scr),total cholesterol, high-density lipoprotein（HDL）, blood pressure(BP). Through ultrasound examination to determinate carotid intima-media thickness (IMT). Again determination of these serum markers and ultrasound examination 6 month after. Using the different value of the two measurements of IMT as the IMTV value. Using the average of two examination results of serum to analysis the relationship between IMTV and the other indicators. P <0.05 description difference was statistically significant. Result: ① The level of Hs-CRP , mean arterial pressure（MAP）and intima-media thickness variability（IMTV）in high permeability group of MPD patients were significantly higher than the low permeability group (P <0.05), HDL was significantly lower than the low permeability group (P <0.05).But no significant differences between the two groups of IMT（P＞0.05）② Pearson correlation analysis found that the IMTV in the peritoneal patients body's was a positive correlation with Hs-CRP, MAP and peritoneal permeability (D / P value) , negative correlation with HDL，no relationship with SBP,DBP and TCH . ③Multivariate logistic regression analysis found， the important influencing factors on IMTV were Hs-CRP levels and D / P value. Conclusion: ①High permeability group of inflammatory conditions is more serious than the low permeability group, this is the independent risk factors affecting the patients on intima-media thickness variability. ② Control the level of micro-inflammation especially for high permeability group is the important means of mitigate the level of IMTV, retard atherosclerosis and reduce the complications of cardiovascular events of MPD patients.

Key words: peritoneal transport characteristics, high-sensitivity C-reactive protein, carotid intima-media thickness, variability