慢性肾脏病患者微炎症状态相关影响因素分析

发布时间：2018-09-16 18:51

【摘要】：背景：近年来，随着对慢性肾脏病（chronic kidney disease，CKD）发病机制及其并发症研究的深入,微炎症状态引起了人们的重视。微炎症状态（microinflammatory state），是指非微生物感染引起的血液循环中细胞因子及正性时相反应蛋白轻度持续升高，并能够促进患者肾功能恶化及并发症发生的慢性非显性炎症状态[1]。C反应蛋白（CRP）是正性时相反应蛋白之一,CRP低水平持续升高，但不超过10-15mg/L是微炎症状态的标志。随着实验方法学的不断改进，超敏C-反应蛋白（hs-CRP）可以检测出低水平的CRP浓度，更早、更好反应CKD患者的微炎症状态反应微炎症状态，健康人的hs-CRP小于3mg/L,当其超过3mg/L，即使的临床感染症状不明显，也代表机体存在感染时相的病理反应过程。CKD患者体内普遍存在微炎症状态，微炎症程度在一定程度上提示CKD患者的预后。因此，明确CKD患者微炎症状态发生机制，对其做到早期检测和干预，有助于提高患者的生存质量，降低病死率。目的：研究慢性肾脏病患者微炎症状态相关影响因素方法：该研究选择2012年1月~2013年1月吉林大学第一医院肾病科住院患者199例，根据其血清超敏C-反应蛋白（hs-CRP）值分为微炎症状态组（hs-CRP＞3mg/L）和正常组（hs-CRP≤3mg/L），其中微炎症状态组100人，正常组99人。分别对两组中患者的年龄、性别、原发病、血压（BP)、血肌酐（Scr）、血红蛋白（Hb）、甘油三酯(TG)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血白蛋白（Alb）等一般临床资料和生化指标以及左室射血分数（EF）、左室舒张末期内径（LVDd）、室间隔厚度（IVST）进行比较分析。采用SPSS19.0软件进行资料数据统计。正态或近似正态分布的计量资料以(x±s)表示，两样本均数比较采用独立样本的t检验；偏态分布的计量资料采用中位数(下四分位数-上四分位数)表示，采用秩和检验进行组间比较；计数资料进行χ2检验。采用直线相关分析(Pearson相关分析)对各资料相关性进行分析，P0.05有统计学意义。结果： 1.一般临床资料：199例CKD患者中，，男性112例，女性87例。原发病中以原发性肾小球疾病为主，共97例（45.73%），其次为糖尿病肾病55例（27.64%）、高血压肾病37例（18.59%）、多囊肾8例（4.02%）、慢性间质性肾炎6例（3.02%）、梗阻性肾病1例（0.5%）、其他1例（0.5%）。微炎症状态组100例（50.25%），正常组99例（49.75%）。微炎症状态组患者透析龄大于正常组，差异有统计学意义（P＜0.05）。各组原发病比较、收缩压及舒张压比较差异均无统计学意义（P＞0.05）。 2.生化指标以及心脏结构和功能指标：与正常组比较，微炎症状态组Scr、LVDd升高，差异有统计学意义（P＜0.05）。Hb、Hct、TP、Alb、TC、LDL-C、EF降低，差异有统计学意义（P＜0.05）。两组间血pr-Alb、TG、HDL-C、ApoA水平差异无统计学意义（P＞0.05）。两组间IVST比较差异无统计学意义（P＞0.05）。 3.相关关系：hs-CRP与Scr、BUN，LVSd之间呈正相关（P＜0.05）。与Hb、Hct、TP、Alb、EF呈负相关。结论： 1、CKD患者中并发微炎症状态的占50.25%，随着肾功能的减退微炎症状态加重，微炎症状态可以促进肾功能恶化。 2、微炎症状态可能促进贫血、营养不良、心功能不全等并发症的发生、发展。
[Abstract]:Background:
In recent years, with the in-depth study of the pathogenesis and complications of chronic kidney disease (CKD), Micro-inflammatory State has attracted much attention. Microinflammatory state refers to the slight and sustained increase of cytokines and positive phase reaction proteins in the blood circulation caused by non-microbial infection. Chronic nondominant inflammatory state that can promote renal function deterioration and complications [1]. C-reactive protein (CRP) is one of the positive phase reaction proteins. Low CRP levels continue to rise, but no more than 10-15mg/L is a marker of microinflammatory state. With the continuous improvement of experimental methodology, hypersensitive C-reactive protein (hs-CRP) can detect low levels. CRP concentration, earlier and better responded to the microinflammatory state of CKD patients, hs-CRP in healthy people was less than 3mg/L, when it was more than 3mg/L, even if the clinical infection symptoms were not obvious, it also represented the pathological reaction process of the body at the time of infection. Therefore, it is helpful to improve the quality of life and reduce the mortality of patients with CKD to clarify the pathogenesis of microinflammation in patients with CKD and to detect and intervene early.
Objective:
Factors related to micro inflammation in patients with chronic kidney disease
Method:
In this study, 199 inpatients in the Department of Nephrology, First Hospital of Jilin University from January 2012 to January 2013 were divided into two groups according to their serum hs-CRP values: Micro-inflammatory group (hs-CRP > 3mg/L) and normal group (hs-CRP < 3mg/L), including 100 patients in Micro-inflammatory group and 99 patients in normal group. General clinical data, blood pressure (BP), serum creatinine (Scr), hemoglobin (Hb), triglyceride (TG), cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), serum albumin (Alb) and left ventricular ejection fraction (EF), left ventricular end-diastolic diameter (LVDd), ventricular septal thickness (IVST) were compared and scored. SPSS19.0 software was used for data statistics. Normal or approximate normal distribution measurements were expressed as (x + s) and the mean of the two samples were compared by t-test of independent samples; skewed distribution measurements were expressed as median (lower quartile-upper quartile), and rank sum test was used for inter-group comparison; and counting data were used for comparison. _2 test. Linear correlation analysis (Pearson correlation analysis) was used to analyze the data correlation, P 0.05 had statistical significance.
Result:
1. General clinical data: Of 199 patients with CKD, 112 were males and 87 were females. Of the primary diseases, 97 were primary glomerular diseases (45.73%), 55 were diabetic nephropathy (27.64%), 37 were hypertensive nephropathy (18.59%), 8 were polycystic kidney disease (4.02%), 6 were chronic interstitial nephritis (3.02%), 1 was obstructive nephropathy (0.5%) and 1 was other (0.5%). There were 100 cases (50.25%) in the inflammatory state group and 99 cases (49.75%) in the normal group. The dialysis age of the patients in the Micro-inflammatory State group was longer than that of the normal group, and the difference was statistically significant (P < 0.05).
2. Biochemical indexes and cardiac structure and function indexes: Compared with the normal group, the levels of Scr and LVDd in the microinflammatory group increased, and the difference was statistically significant (P < 0.05). Hb, Hct, TP, Alb, TC, LDL-C, EF decreased, and the difference was statistically significant (P < 0.05). There was no significant difference in the levels of pr-Alb, TG, HDL-C and ApoA between the two groups (P > 0.05). The difference was not statistically significant (P > 0.05).
3. correlation: hs-CRP was positively correlated with Scr, BUN and LVSd (P < 0.05), and negatively correlated with Hb, Hct, TP, Alb and EF.
Conclusion:
1. Microinflammation accounted for 50.25% of CKD patients. With the decline of renal function, microinflammation can promote the deterioration of renal function.
2, micro inflammatory state may promote anemia, malnutrition, heart failure and other complications.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692

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