慢性肾脏病不同阶段纤维蛋白原与动脉粥样硬化关系的相关研究

发布时间：2018-03-16 21:24

本文选题：纤维蛋白原　切入点：慢性肾脏病　出处：《蚌埠医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过检测慢性肾脏病(chronic kidney disease,CKD)患者血清中纤维蛋白原(fibrinogen,,FIB)水平证明CKD患者存在高FIB状态,以及CKD患者中因动脉粥样硬化(atherosclerosis,AS)致心血管疾病(cardiovascular disease,CVD)的发病率较高,两者间存在关联。在对心血管事件常规治疗措施之外,对干预FIB水平是否可以降低CVD事件的发生发展,并进一步改善CKD预后的研究提供理论基础。方法:搜集蚌埠医学院第一附属医院肾内科2016年01月-2016年10月原发性中晚期慢性肾脏病患者90例,按照CKD分期标准分组,CKD3期、CKD4期以及CKD5期各为1组,共3组。记录并随访姓名、年龄、性别、吸烟史、原发病及心血管病史等,同时选择同期健康体检者30例作为对照组。收集患者资料及相关生化指标,采用酶联免疫吸附法测定所有入组者纤维蛋白原。入选患者采用彩色多普勒超声检测颈动脉内中膜厚度(IMT)。应用SPSS18.0软件进行统计学分析,以P0.05为差异有统计学意义。结果:1.CKD3-5期患者血清FIB及D-二聚体水平:CKD3-5期患者FIB及D-二聚体水平都高于对照组(P0.05),且随着e GFR下降有上升趋势。2.CKD3-5期患者颈动脉彩超结果:CKD3-5期患者的颈动脉IMT厚度、颈动脉IMT增厚率及斑块发生率与健康对照组相比均有升高(P0.05)。3.CKD3-5期患者动脉粥样硬化与血清FIB、D-二聚体水平的关系:根据颈动脉彩超检查结果将CKD患者分为颈动脉正常组、IMT增厚无斑块组及斑块形成组。斑块形成组的血清FIB水平与颈动脉正常组比IMT增厚无斑块组显著增高(P0.05),IMT增厚无斑块组的血清FIB水平高于正常组(P0.05)。斑块形成组的血清D-二聚体水平高于正常组(P0.05)。4.CKD3-5期患者FIB水平与IMT、e GFR直线相关分析:血清FIB水平、D-二聚体水平均与IMT呈正相关(r=0.724、0.486,P.05),与e GFR呈负相关(r=-0.483、-0.451,P.05)。颈动脉IMT与e GFR水平呈负相关(r=-0.566,P.05)。血清FIB水平与D-二聚体水平呈正相关(r=0.539,P0.05)。5.多重线性逻辑回归显示:血清FIB(β=7.094,P0.05)、D-二聚体(β=15.118,P0.05)、TG(β=0.002,P0.05)、LDL(β=3.472,P0.05)水平是CKD3-5期患者颈动脉IMT增厚的危险因素。结论:1.CKD3-5期患者颈动脉粥样硬化发生率与正常人相比明显升高;2.CKD3-5期患者FIB水平显著升高,D-二聚体水平升高。3.FIB水平、D-二聚体水平的增高与CKD3-5期患者发生动脉粥样硬化相关。
[Abstract]:Objective: to detect the level of fibrinogen fibrinogenin (kidney) in the serum of patients with chronic renal disease (kidney) and to prove that there is a high level of FIB in patients with CKD and a higher incidence of cardiovascular disease caused by atherosclerosis in patients with CKD. There is a correlation between the two. In addition to routine treatment of cardiovascular events, whether intervention in FIB level can reduce the occurrence and development of CVD events, Methods: from January 2016 to October 2016, 90 patients with primary and advanced chronic kidney disease in the Department of Nephrology, the first affiliated Hospital of Bengbu Medical College, were collected. According to the standard of CKD staging, the patients were divided into three groups respectively: CKD3, CKD4 and CKD5. Their names, age, sex, smoking history, primary disease and cardiovascular history were recorded and followed up. At the same time, 30 healthy persons were selected as control group. The data of patients and related biochemical indexes were collected. The fibrinogen was measured by enzyme-linked immunosorbent assay (Elisa). The carotid intima media thickness (IMTT) was detected by color Doppler ultrasound. SPSS18.0 software was used for statistical analysis. Results 1. The serum FIB and D- dimer levels in patients with CKD3-5 were significantly higher than those in the control group (P 0.05), and with the decrease of e GFR, there was an increasing trend of carotid artery color Doppler ultrasound in patients with phase 3-5 of CKD3.The results of color Doppler ultrasound showed that the levels of FIB and D- dimer in patients with phase 3-5 were higher than those in the control group (P < 0.05). IMT thickness of carotid artery in patients with stage 3 to 5, Carotid IMT thickening rate and plaque incidence were higher than those of healthy control group. 3. The relationship between atherosclerosis and serum FIBD- dimer level in patients with CKD3-5: according to the results of carotid color Doppler ultrasound, the patients with CKD were divided into normal carotid artery. The level of serum FIB in plaque formation group was significantly higher than that in normal carotid artery group compared with IMT thickening without plaque group. The level of serum FIB in plaque free plaque group was significantly higher than that in normal plaque group. The level of serum D- dimer was higher than that of normal group (P0.05n. 4. CKD3-5). There was a linear correlation analysis between FIB level and IMTX GFR. The serum FIB level was positively correlated with IMT (r 0.724 0. 486p. 05), and negatively correlated with e GFR (P 0. 483- 0. 451p05). There was a negative correlation between IMT and e GFR in carotid artery. Serum FIB level was positively correlated with D- dimer level. Multiplex linear regression analysis showed that serum FIB level was a risk factor for carotid artery IMT thickening in patients with CKD3-5. Conclusion: serum FIB-15.118P0.05TGis (尾 0.002P0.05P0.05) is a risk factor for carotid artery IMT thickening in patients with CKD3-5. Conclusion\\\;\\\; 1. The FIB level of CKD3-5 patients was significantly higher than that of normal controls. 3. The increase of D-dimer level was associated with atherosclerosis in patients with CKD3-5 stage.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692;R543.5

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