透析患者微炎状态和甲状旁腺激素与颈动脉硬化的关系
发布时间：2019-06-18 18:48
【摘要】：目的临床观察发现维持性血液透析(MHD)患者心血管疾病的发生率和死亡率明显增高,其中动脉粥样硬化(AS)是心血管疾病发生发展的重要危险因素。而AS的传统危险因素如年龄、高血压、高血糖、高密度脂蛋白胆固醇降低及低密度脂蛋白胆固醇升高等,不足以预测MHD患者心血管疾病的危险性,提示还存在一些其他非传统的危险因素。本课题研究主要探讨MHD患者微炎状态和血清甲状旁腺激素水平(PTH)水平与颈动脉内膜一中层厚度(IMT)的相关性,以及两者在MHD患者动脉粥样硬化发生中的作用,为进一步探讨预防和治疗MHD患者心血管高风险性的方法奠定基础。方法在解放军第八十八医院院血液净化中心随机选取90例维持性血液透析(MHD)患者(其中男性54例,女性36例),透析时间10~120个月,另取同期年龄及性别比例与病例组相匹配的在本院查体正常的30例为对照组(男性18例,女性12例),病例组和对照组共120例。所有实验对象均进行颈动脉血管彩色多普勒超声检查,记录斑块的有无,颈动脉内中膜厚度,详细询问并记录研究对象的临床资料。详细询问研究对象的既往史,个人史及家族史。所有受试对象于透析前禁食8-10小时,于次日清晨空腹卧位抽取肘静脉血约6-8ml,应用全自动生化分析仪测定常规生化指标,其中包括血常规(Rt)、血清肌酐(Scr)、尿素氮(BUN)、血糖、总胆固醇(Ch)、甘油三酯(TG)、血清总蛋白(TP)和白蛋白(ALB)等。同时空腹状态下检测患者血清甲状旁腺激素,C-反应蛋白、IL-6、TNF-α。所有数据采用SPSS15.0统计软件处理。结果1.维持性血液透析(MHD)患者血清C-反应蛋白、IL-6、TNF-α水平健康对照组比较:MHD患者C反应蛋白水平(8.943±9.9622ng/ml)明显高于对照组(1.746±1.2483ng/ml)(P0.05);MHD患者IL-6水平(158.0888±2.8308pg/ml)明显高于对照组(85.077±35.9416pg/ml)P0.05);MHD患者TNF-α水平(106.36±47.953ng/l)明显高于对照组(106.36±47.953ng/l)(P0.05)。2.维持性血液透析(MHD)患者甲状旁腺激素水平与对照组比较:MHD患者甲状旁腺激素水平(183.532±252.1534pg/ml)明显高于对照组(29.520±15.5312pg/ml)(P0.05)。3.维持性血液透析(MHD)患者颈动脉IMT水平与对照组比较:MHD患者颈动脉IMT水平(1.308±0.7053mm)明显高于对照组(0.451±0.3999mm)(P0.05)。4.维持性血液透析(MHD)患者颈动脉超声异常组(包括内膜增厚及斑块形成)与颈动脉超声正常组血清C-反应蛋白、IL-6、TNF-α水平和甲状旁腺激素水平比较:动脉超声异常组C-反应蛋白、IL-6、TNF-α水平和甲状旁腺激素明显高于颈动脉超声正常组(P0.05)。5.维持性血液透析(MHD)患者高CRP组PTH水平及颈动脉IMT水平与CRP正常组比较:高CRP组PTH水平及颈动脉IMT水平明显高于CRP正常组(P0.05)。6.维持性血液透析(MHD)患者高PTH组CRP水平及颈动脉IMT水平与PTH正常组比较:高PTH组CRP水平及颈动脉IMT水平明显高于PTH正常组(P0.05)。7.多元线性回归分析显示:维持性血液透析(MHD)患者颈动脉IMT与血清PTH(β=0.177 P0.05)、C-反应蛋白(β=0.244 P0.05)、血红蛋白、白蛋白等密切相关。提示血PTH与C-反应蛋白直接参与了动脉粥样硬化、粥样斑块的形成。8.Logistic逐步回归分析显示:血清PTH水平(β=1.999 95%CI:2.732-19.954 P0.01)是MHD患者动脉粥样硬化的独立危险因素之一。结论1.MHD患者普遍存在微炎症状态和高PTH血症。2.高PTH血症与微炎症状态和MHD患者高发动脉粥样硬化性心血管事件相关。3.血清PTH可能和微炎症反应相互作用而且共同参与了MHD患者动脉粥样硬化的形成。
[Abstract]:Objective To observe the incidence and mortality of cardiovascular diseases in patients with maintenance hemodialysis (MHD), and atherosclerosis (AS) is an important risk factor for the development of cardiovascular disease. The traditional risk factors of AS, such as age, hypertension, hyperglycemia, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, are not enough to predict the risk of cardiovascular disease in patients with MHD, and there are some other non-traditional risk factors. The relationship between the level of microinflammation and the level of serum parathyroid hormone (PTH) and the intima-media thickness (IMT) in the patients with MHD and the role of both in the occurrence of atherosclerosis in patients with MHD were studied. To further explore the method of preventing and treating high risk of cardiovascular high risk in patients with MHD. Methods 90 patients with maintenance hemodialysis (MHD) (54 male and 36 female) were randomly selected in the blood purification center of the Eighth Hospital of the People's Liberation Army (PLA), and the dialysis time was 10-120 months. A total of 120 cases of the control group (18 males and 12 females) and 120 cases of the control group were matched with the case group in the same age and sex ratio. All the subjects were examined by carotid artery color Doppler ultrasound, the presence or absence of the plaque, the thickness of the media in the carotid artery, and the clinical data of the subject. The study object's previous history, personal history, and family history were asked in detail. All subjects were fasted for 8-10 hours prior to dialysis, and the elbow venous blood was extracted in an empty position on the morning of the next morning for about 6-8 ml, and the routine biochemical indexes were measured by a full-automatic biochemical analyzer, including blood routine (Rt), serum myoglobin (Scr), urea nitrogen (BUN), blood sugar and total cholesterol (Ch). Triglyceride (TG), total serum protein (TP) and albumin (ALB), etc. In the same time, the serum parathyroid hormone, C-reactive protein, IL-6 and TNF-1 were detected in the fasting state. All data is processed using the SPSS10.0 statistical software. Results 1. The serum C-reactive protein, IL-6 and TNF-1 levels in the patients with maintenance hemodialysis (MHD) were compared with those in the control group: the level of C-reactive protein in MHD patients (8.943-9.9622 ng/ ml) was significantly higher than that in the control group (1.746-1.2483 ng/ ml) (P0.05); The level of IL-6 in MHD patients (158.0888-2.8308 pg/ ml) was significantly higher than that in the control group (85.077 and 35.9416 pg/ ml) (P0.05); the level of TNF-6 in MHD patients (106.36, 47.953 ng/ l) was significantly higher than that in the control group (106.36, 47.953 ng/ l) (P0.05). The level of parathyroid hormone in patients with maintenance hemodialysis (MHD) was compared with that of the control group: the level of parathyroid hormone (183.532, 252.1534 pg/ ml) in MHD patients was significantly higher than that in the control group (29.520-15.5312 pg/ ml) (P0.05). The IMT of the carotid artery in the patients with maintenance hemodialysis (MHD) was compared with that of the control group: the IMT of the carotid artery in MHD patients (1.308, 0.7053 mm) was significantly higher than that in the control group (0.451, 0.3999 mm) (P0.05). The serum C-reactive protein, IL-6, TNF-1 level and parathyroid hormone level in the carotid ultrasound abnormal group (including intimal thickening and plaque formation) in the patients with maintenance hemodialysis (MHD) were compared with the serum C-reactive protein, IL-6, TNF-1 level and parathyroid hormone level in the normal group of carotid ultrasound: C-reactive protein, IL-6, The level of TNF-1 and the parathyroid hormone were significantly higher than that of the normal carotid artery (P0.05). The levels of PTH and IMT of the high CRP group in the patients with maintenance hemodialysis (MHD) were higher than those in the normal group (P <0.05). The level of CRP and IMT of the high PTH group in the patients with maintenance hemodialysis (MHD) were higher than that in the normal group of PTH (P0.05). The multivariate linear regression analysis showed that the IMT of the carotid artery IMT in the maintenance hemodialysis (MHD) was closely related to the serum PTH (P = 0.177 P0.05), the C-reactive protein (P = 0.244 P.05), the hemoglobin, the albumin, and so on. The results showed that PTH and C-reactive protein were directly involved in the formation of atherosclerosis and the formation of atheromatous plaque. Logistic regression analysis showed that the serum PTH level (P = 1.999 95% CI: 2.732-19.954P0.01) was one of the independent risk factors of atherosclerosis in patients with MHD. Conclusion 1. There is a prevalence of microinflammation and high PTH in MHD patients. High PTH is associated with a high incidence of atherosclerotic cardiovascular events in patients with microinflammation and MHD. Serum PTH may interact with the microinflammatory reaction and co-operate with the formation of atherosclerosis in patients with MHD.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5;R54
本文编号：2501703
[Abstract]:Objective To observe the incidence and mortality of cardiovascular diseases in patients with maintenance hemodialysis (MHD), and atherosclerosis (AS) is an important risk factor for the development of cardiovascular disease. The traditional risk factors of AS, such as age, hypertension, hyperglycemia, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, are not enough to predict the risk of cardiovascular disease in patients with MHD, and there are some other non-traditional risk factors. The relationship between the level of microinflammation and the level of serum parathyroid hormone (PTH) and the intima-media thickness (IMT) in the patients with MHD and the role of both in the occurrence of atherosclerosis in patients with MHD were studied. To further explore the method of preventing and treating high risk of cardiovascular high risk in patients with MHD. Methods 90 patients with maintenance hemodialysis (MHD) (54 male and 36 female) were randomly selected in the blood purification center of the Eighth Hospital of the People's Liberation Army (PLA), and the dialysis time was 10-120 months. A total of 120 cases of the control group (18 males and 12 females) and 120 cases of the control group were matched with the case group in the same age and sex ratio. All the subjects were examined by carotid artery color Doppler ultrasound, the presence or absence of the plaque, the thickness of the media in the carotid artery, and the clinical data of the subject. The study object's previous history, personal history, and family history were asked in detail. All subjects were fasted for 8-10 hours prior to dialysis, and the elbow venous blood was extracted in an empty position on the morning of the next morning for about 6-8 ml, and the routine biochemical indexes were measured by a full-automatic biochemical analyzer, including blood routine (Rt), serum myoglobin (Scr), urea nitrogen (BUN), blood sugar and total cholesterol (Ch). Triglyceride (TG), total serum protein (TP) and albumin (ALB), etc. In the same time, the serum parathyroid hormone, C-reactive protein, IL-6 and TNF-1 were detected in the fasting state. All data is processed using the SPSS10.0 statistical software. Results 1. The serum C-reactive protein, IL-6 and TNF-1 levels in the patients with maintenance hemodialysis (MHD) were compared with those in the control group: the level of C-reactive protein in MHD patients (8.943-9.9622 ng/ ml) was significantly higher than that in the control group (1.746-1.2483 ng/ ml) (P0.05); The level of IL-6 in MHD patients (158.0888-2.8308 pg/ ml) was significantly higher than that in the control group (85.077 and 35.9416 pg/ ml) (P0.05); the level of TNF-6 in MHD patients (106.36, 47.953 ng/ l) was significantly higher than that in the control group (106.36, 47.953 ng/ l) (P0.05). The level of parathyroid hormone in patients with maintenance hemodialysis (MHD) was compared with that of the control group: the level of parathyroid hormone (183.532, 252.1534 pg/ ml) in MHD patients was significantly higher than that in the control group (29.520-15.5312 pg/ ml) (P0.05). The IMT of the carotid artery in the patients with maintenance hemodialysis (MHD) was compared with that of the control group: the IMT of the carotid artery in MHD patients (1.308, 0.7053 mm) was significantly higher than that in the control group (0.451, 0.3999 mm) (P0.05). The serum C-reactive protein, IL-6, TNF-1 level and parathyroid hormone level in the carotid ultrasound abnormal group (including intimal thickening and plaque formation) in the patients with maintenance hemodialysis (MHD) were compared with the serum C-reactive protein, IL-6, TNF-1 level and parathyroid hormone level in the normal group of carotid ultrasound: C-reactive protein, IL-6, The level of TNF-1 and the parathyroid hormone were significantly higher than that of the normal carotid artery (P0.05). The levels of PTH and IMT of the high CRP group in the patients with maintenance hemodialysis (MHD) were higher than those in the normal group (P <0.05). The level of CRP and IMT of the high PTH group in the patients with maintenance hemodialysis (MHD) were higher than that in the normal group of PTH (P0.05). The multivariate linear regression analysis showed that the IMT of the carotid artery IMT in the maintenance hemodialysis (MHD) was closely related to the serum PTH (P = 0.177 P0.05), the C-reactive protein (P = 0.244 P.05), the hemoglobin, the albumin, and so on. The results showed that PTH and C-reactive protein were directly involved in the formation of atherosclerosis and the formation of atheromatous plaque. Logistic regression analysis showed that the serum PTH level (P = 1.999 95% CI: 2.732-19.954P0.01) was one of the independent risk factors of atherosclerosis in patients with MHD. Conclusion 1. There is a prevalence of microinflammation and high PTH in MHD patients. High PTH is associated with a high incidence of atherosclerotic cardiovascular events in patients with microinflammation and MHD. Serum PTH may interact with the microinflammatory reaction and co-operate with the formation of atherosclerosis in patients with MHD.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5;R54
【参考文献】
相关期刊论文 前2条
1 张桦,唐世聪;甲状旁腺素:透析病人的一种新的生存指标[J];国外医学.泌尿系统分册;1999年01期
2 王剑青,邓安国,戴勇;维持性血液透析患者微炎症状态相关因子的变化[J];临床内科杂志;2005年07期
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