慢性肾脏病患者血清白细胞介素-2水平与病情及相关病变的临床研究

目的探讨慢性肾脏病(CKD)患者血清白细胞介素-2(IL-2)水平及临床意义。方法按照NKF-K/DOQI标准,采用酶联免疫法对CKD患者61例和健康对照组(n=25例)测定血清IL-2含量,并检测相关临床指标,分析血清IL-2水平与肾功能、心血管病变及其他临床资料的关系。结果CKD组患者血清IL-2含量较健康对照组显著升高(P<0.05),肾功能3、4、5级患者血清IL-2水平较肾功能1、2级显著升高(P均<0.05);相关分析显示CKD患者血清IL-2水平与血肌酐呈显著正相关(r= 0.412,P<0.05),与内生肌酐清除率呈显著负相关(r=-0.326,P<0.05)。心血管病变组血清IL-2水平显著高于无心血管病变组(P<0.01),高血清IL-2组心血管病变发生率显著高于正常血清IL-2组(P<0.01)。41例肾功能2～5级的CKD患者血清IL- 2水平与三酰甘油、低密度脂蛋白胆固醇、磷呈显著正相关(P<0.05),与血钙呈显著负相关(P<0.01),与年龄、病程、血压、总胆固醇、高密度脂蛋白胆固醇、血红蛋白、清蛋白无显著相关(P>0.05);回归分析显示血清IL-2水平依次与内生肌酐清除率、血钙和三酰甘油关系最为密切。结论CKD患者血清IL-2水平升高,可能与肾功能减退时严重代谢紊乱引起的T细胞活化有关。IL-2升高本身可能作为损伤因子,参与肾功能恶化,并与心血管病变的发生可能有关。

Clinical research on the relationships between serum IL-2 level and pathogenetic condition as well as related diseases in patients with chronic renal disease

Objective To investigate the serum level of interleukin-2(IL-2)in patients with chronic renal disease and to find out its clinical significance.Methods According to the standard of NKF-K/DOQI,61 patients with chronic renal disease(disease group)and 25 healthy people(control group)were enrolled in the investigation.Serum level of IL-2 was determined by ELISA as- say.Some related clinical indicators were detected at the same time.The relationships were analyzed between the serum IL-2 level and renal function,cardiovascular disease(CVD),and other clinical indicators.Results The serum level of IL-2 was significantly higher in disease group than that in control group(P<0.05).In disease group,the serum IL-2 level was significantly higher in pa- tients with grade 3,4,5 renal function than that patients with grade1,2(P<0.05);positive correlation was found between the serum IL-2 level and serum creatinine(SCr)(r=0.412,P<0.05),and negative correlation found between the serum IL-2 level and endogenous creatinine clearance rate(Ccr)(r=0.326,P<0.05).The serum level of IL-2 was significantly higher in CVD group than that in non-CVD group(P<0.01),and the incidence of CVD was much higher in elevated serum IL-2 group than that normal in IL-2 group(P<0.01).In 41 chronic renal disease patients with grade 2-5 renal function,serum level of IL-2 was posi- tively correlative to serum triglyceride(TG),low density lipoprotein(LDL),and phosphorus(P)(P<0.05),negatively correla- tive to blood calcium,but no correlative to age,course,blood pressure,the level of total cholesterol(TC),high density lipopro- tein(HDL),hemoglobin(Hb),and albumin(ALB)(P<0.05).The stepwise regression analysis showed that the serum IL-2 level was mostly correlated to creatinine clearance,Ca~(2 ),and TG successively.Conclusion The elevated serum IL-2 level may be associated with T cell activation resulting from severe metabolic disorder during the renal hypofunction period,which contributes to deterioration of renal function and occurrence of CVD.