慢性肾脏疾病患者sCD_（146）与肾功能的关系及其临床意义探讨

目的：探讨外周血sCD146水平检测在评估慢性肾脏疾病（CKD）进程中的意义及其与肾功能的关系。方法：入选84例CKD患者,CKD3期15例,CKD4期21例,CKD 5期48例,其中非透析组（CKD 5-ND）11例,腹透组（CKD 5-PD）22例,血透组（CKD5-HD）15例。设20例健康对照。采用ELISA法检测sCD146水平。分析sCD146的变化及其相关因素,特别是与肾功能的关系。结果：各组CKD患者sCD146水平[CKD3（290.14±28.52）ng/ml,CKD4（348.37±26.96）ng/ml,CKD5-ND（426.42±30.72）ng/ml,CKD5-PD（460.29±42.11）ng/ml,CKD 5-HD（467.45±69.05）ng/ml],均显著高于对照组（206.40±29.39）ng/ml。sCD146水平随着CKD3～5期进展而逐渐升高（P〈0.05）,而且血透和腹透组患者的sCD146水平分别高于CKD5-ND组。相关分析表明sCD146与Scr、β2-MG、CRP呈正相关,与GFR和血红蛋白呈负相关。多因素逐步回归分析显示GFR和β2-MG是影响sCD146水平的独立因素。结论：sCD146能较好地反映CKD患者的肾功能进展情况;sCD146在CKD患者中的表达增强一定程度上反映了血管内皮功能状况,与慢性炎症状态有关。

Relationship between Soluble CD146 and Renal Function in Patients with Chronic Kidney Disease

Objective：To detect the level of soluble CD146（sCD146） and explore its relationship with renal fuction in patients with chronic kidney disease（CKD）.Methods：A total of 84 CKD patients,including 15 cases of CKD3,21 cases of CKD4,48 cases of CKD5 with 11 non-dialysis cases（CKD5-ND）,22 peritoneal dialysis casese （CKD5-PD） and 15 hemodialysis cases（CKD5-HD）.20 healthy volunteers were enrolled as control.Serum levels of CD146 were measured by ELISA.Results：The serum levels of CD146 in each CKD group are [CKD3（290.14±28.52）ng/ml,CKD4（348.37±26.96）ng/ml,CKD5-ND（426.42±30.72）ng/ml,CKD5-PD（460.29±42.11）ng/ml,CKD5-HD（467.45±69.05）ng/ml],which is significantly higher than in control group（206.40±29.39）ng/ml.Serum CD146 levels were gradually increased according to the progression of renal impairment from CKD3 to CKD5（P0.05）,and that in the peritoneal or hemodialysis group,sCD146 was significantly higher than in CKD5-ND group.sCD146 level was positively correlated with Scr,β2 microglobulin and CRP,and negatively correlated with GFR and hemoglobin.In stepwised regression analysis,GFR and β2 microglobulin remain the only independent factors of sCD146 levels.Conclusion：sCD146 could be a new biomarker of renal function and may show renal impairment in the different stages of CKD.Serum CD146 may closely associate with the endothelial dysfunction and chronic inflammation.