腹膜透析患者颈动脉内膜中层厚度变异性与C反应蛋白水平及腹膜转运特性间的关系

【摘要】目的探讨持续性不卧床腹膜透析（continuousambulatoryperitonea]dialysiS，CAPD）患者的腹膜转运特性与体内超敏C反应蛋白（High—sensitivityC-reactiveprotein，Hs—CRP）及颈动脉（carotid）内膜一中层厚度变异性（intima—mediathicknesSvariability，IMTV）间的关系。方法选取随访的维持性腹膜透析6个月以上的患者通过PET将患者分为高通透性组（D／P〉0．65）和低通透性组（D／P≤0．65）组。根据PET结果制定PD处方，使每周肌酐清除率CCr〉50L／W·1．73m2，Kt／v≥1．7。同时测定患者超敏C-反应蛋白（Hs—CRP）、血肌酐（Scr）、总胆固醇（TCH）、高密度脂蛋白（HDL）及血压。并予以颈动脉内膜血管彩超检查，测定颈动脉内膜一中层厚度（intima—mediathicknessvariability，IMT）。6个月后，再次测定上述血清指标及行超声检查，血检指标取2次检测结果的平均值，并根据超声检查结果计算6个月前后颈动脉内膜一中层厚度的变异性（IMTV），分析不同腹膜转运特性患者体内Hs—CRP水平、Scr、血压、TCH、HDL、IMT、IMTV间的差异性，并分析影响IMTV的因素。P〈0．05说明差异有统计学意义。结果①MPD高通透性组患者的Hs—CRP水平、平均动脉压（MAP）、IMTV等明显高于低通透性组（P〈0．05），HDL水平明显低于低通透性组（P〈0．05），而IMT无明显差异（P〉0．05）。②Pearson相关分析发现，患者体内IMTV与Hs—CRP水平、MAP、腹膜的通透性（D／P值）等呈正相关，与HDL呈负相关，与SBP、DBP、TCH无关。③多因素回归分析发现，影响IMTV的独立危险因素有Hs—CRP水平、D／P值。结论①高通透性组的微炎症状态重于低通透性组，微炎症状态和腹膜转运特性是影响MPD患者颈动脉内膜一中层厚度变异性的主要因素。②控制PD患者尤其是腹膜高转运状态PD患者体内的微炎症水平对降低其颈动脉内膜一中层厚度变异性、延缓动脉硬化并减少MPD患者心血管事件并发症有重要意义。

Studies on the correlations among carotid intima-media thickness variability, serum high-sensitivity Creactive protein level, and peritoneal permeability in continuous ambulatory peritoneal dialysis patients

Objective To study the correlations among high-sensitivity C-reactive protein （Hs-CRP） level, carotid intima-media thickness variability and peritoneal permeability in continuous ambulatory perito- neal dialysis （CAPD） patients. Methods We recruited 56 CAPD patients who were followed up for more than 6 months in the peritoneal dialysis center of this hospital. CAPD patients with peritonitis, Based on the value of peritoneal equihbration test （PET）, patients were divided into high permeability group （D/P 〉 0.65） and low permeability group （D/P =0.65）, and their dialysis doses were prescribed to achieve weekly creatinine clear- ance rate （Ccr） 〉50L/W ~ 1.73m2 and urea clearance index （Kt/V） 〉/ 1.7. Serum Hs-CRP, creatinine （Scr）, total cholesterol （TCH）, high-density lipoprotein （HDL） and blood pressure （BP） were measured, and carotid intima-media thickness （IMT） was determined by ultrasonography. These examinations were repeated after 6 months. Carotid intima-media thickness variability （IMTV） was defined as the difference of the two IMT values, and the average serum parameters were obtained from the two examinations. We then analyzed the Hs- CRP, Scr, BP, TCH, HDL, IMT, IMTV, and the factors affecting 1MTV in CAPD patients with different peritoneal permeability. P〈0.05 was recognized as statistical significance. Result （a） In high permeability group, serum Hs-CRP, mean arterial pressure （MAP） and IMTV were increased （P 〈0.05）, serum HDL was decreased （P〈0.05）, and IMT was unchanged （P 〉 0.05）, as compared with those in low permeability group.（b） Pearson correlation analysis found that IMTV was positively correlated with Hs-CRP, MAP and peritoneal permeability （D/P value）, and was negatively correlated with HDL, but was unrelated to SBP, DBP and TCH. （c） Multivariate logistic regression analysis found that Hs-CRP level and D/P value were the independent risk factors for IMT. Conclusion （a） Micro-inflammation status was more serious in high permeability group than in low permeability group. Micro-inflammation and peritoneal transport characteristics were the main factors that affect IMTV in CAPD patients. （b） Control of the micro- inflammation status is essential for the prevention of IMTV and atherosclerosis progression as well as cardiovascular events in CAPD patients especially in those with high peritoneal permeability.