脂联素及相关炎症因子在终末期肾病患者颈动脉粥样硬化中的作用

发布时间：2018-06-20 12:33

  本文选题：终末期肾病 + 脂联素　； 参考：《右江民族医学院》2017年硕士论文

【摘要】：目的:探讨脂联素(Adiponectin,ADPN)及相关炎症因子在终末期肾病(End-Stage Renal Disease,ESRD)并颈动脉粥样硬化(Carotid atherosclerosis,CAS)患者体内的表达及相关性,并分析其在CAS形成中的可能分子机制。方法:采用病例-对照研究,选取2015年3月至2016年3月在我院肾内科住院治疗并确诊为颈动脉粥样硬化的ESRD患者64例为实验组(即ESRD组),颈动脉粥样硬化的非慢性肾脏病(Chronic Kidney Disease,CKD)患者42例为阳性对照组(即非CKD组),同期健康体检者30例为正常对照组。采用酶联免疫吸附法检测外周血清脂联素、肿瘤坏死因子-ɑ(Tumor Necrosis Factor Alpha,TNF-α)的浓度;肌氨酸氧化酶法检测血清肌酐;脲酶连续监测法检测血清尿素氮;免疫透射比浊法检测血清C反应蛋白(C Reactive Protein,CRP);采用实时荧光定量PCR(Real-Time PCR,RT-PCR)法检测外周血单个核细胞脂联素DNA表达水平;采用高分辨超声技术检测颈动脉内膜-中层厚度(Internal Carotid Artery IntimaMiddle Thickness,IMT)及粥样硬化斑块。所有数据采用均数±标准差表示,各组间比较采用单因素方差分析,相关性分析采用pearson相关分析,独立危险因素分析采用多因素Logistic回归分析。结果:ESRD组的CRP、TNF-ɑ、IMT分别为11.18±8.62 mmol/L、37.69±12.73ng/L和0.79±0.13 mm,高于正常对照组的4.28±3.86 mmol/L、30.30±9.96 ng/L和0.56±0.10 mm(均P0.01),低于非CKD组的18.19±11.67 mmol/L、124.86±37.86ng/L和0.98±0.14mm(均P0.01);ADPN为46.20±10.62μg/mL,高于正常对照组(13.15±4.33μg/mL)和非CKD组(4.99±1.48μg/mL)(均P0.01);ADPN mRNA相对表达量为0.185±0.121,低于正常对照组(1.502±1.09)(P0.01),与非CKD组(0.184±0.095)比较差异无统计学意义;ADPN与BUN、Scr、eGFR的相关系数分别为0.634、0.638、-0.871(均P0.01);ADPN与CRP、TNF-ɑ、IMT的相关系数分别为-0.307、-0.779和-0.538(均P0.01);CRP与BUN、Scr、eGFR的相关系数分别为0.952、0.832、-0.925(均P0.01);TNF-ɑ与BUN、Scr、eGFR的相关系数分别为0.973、0.862、-0.916(均P0.01);IMT与CRP、TNF-ɑ的相关系数分别为0.912和0.896(均P0.01);CRP、TNF-ɑ的OR值分别为27.376和36.512,95%CI值分别为1.935~387.325和1.335~998.385。结论:(1)ESRD并发CAS患者存在ADPN mRNA低表达和血清ADPN浓度升高现象,ADPN与eCFR呈负相关,提示ADPN血清浓度升高可能不是mRNA调控所致,而受肾功能影响;(2)ESRD并发CAS患者存在微炎症状态,IMT与CRP、TNF-α呈正相关,CRP、TNF-α是ESRD患者并发CAS的独立危险因素;(3)ESRD并发CAS患者ADPN与IMT、CRP、TNF-α呈负相关,ADPN可能具有抑制炎症反应及抑制ESRD患者动脉粥样硬化的作用。
[Abstract]:Objective: to investigate the expression and correlation of adiponectin Adiponectin (ADPN) and related inflammatory factors in patients with end-stage nephropathy (ESRD) and carotid atherosclerosis (CAS), and to analyze its possible molecular mechanism in the formation of CAS. Methods: a case-control study was conducted. From March 2015 to March 2016, we selected 64 ESRD patients who were hospitalized in our hospital from March 2015 to March 2016 and diagnosed carotid atherosclerosis as experimental group (ESRD group). 42 patients with carotid atherosclerosis were treated with Chronic Kidney Disease CKD. Sex control group (non-CKD group), 30 cases of health check-up at the same time as the normal control group. Serum levels of adiponectin, Tumor Necrosis Factor Alpha-TNF- 伪, creatinine oxidase and urea nitrogen in serum were detected by enzyme-linked immunosorbent assay (Elisa). Serum C-reactive protein was detected by immunoturbidimetry and adiponectin DNA expression in peripheral blood mononuclear cells (PBMC) was detected by real-time fluorescence quantitative PCR- Real-Time PCR- (RT-PCRR) method, and immunoturbidimetric assay was used to detect the expression of adiponectin DNA in peripheral blood mononuclear cells (PBMC). Carotid intima-media thickness (IMT) and atherosclerotic plaque were detected by high resolution ultrasound. All the data were expressed as mean 卤standard deviation. The analysis of variance of single factor, pearson correlation analysis and multivariate logistic regression analysis were used in correlation analysis and independent risk factor analysis. 缁撴灉:ESRD缁勭殑CRP,TNF-蓱,IMT鍒嗗埆涓，

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