中老年维持性血透患者微炎症状态相关因子与左心室重塑的关系

目的：探讨维持性血液透析患者（MHD）血中C反应蛋白（CRP）、白细胞介素-1（IL-1）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）、血清白蛋白（Alb）与其心脏结构和功能指标之间关系，MHD患者微炎症状态相关因子与左心室重塑的关系。方法：随机选择老年MHD患者30例、中年MHD患者30例、健康人（对照组）28例，分别检测CRP、IL-1、IL-6、IL-10、TNF-α、Alb水平，并应用超声心动图测定他们的左房内径（LAD）、左心室舒张末内径（LVDd）、左心室收缩末内径（LVDs）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、左心室射血分数（LVEF）、计算左心室心肌重量指数（LVMI），胸部平片计算心胸比率。分析炎症与左心关系。结果：MHD患者中CRP、IL-1、IL-6、IL-10、TNF-α等指标明显高于对照组，三者差异有统计学意义（P〈0．05）；MHD患者LAD、LVIM、LVDs、IVST、LVWPT值均明显高于对照组，三者差异有统计学意义（P〈0．05）；Alb、LVEF较正常对照组明显降低（P〈0．05）；LVMI较正常对照组显著升高（P〈0．01）。CRP、IL-1、IL-6、TNF-α分别与LAD、LVDs、LVD、IVST、LVWPT、LVMI呈正相关（P〈0．05），与LVEF呈负相关（P〈0．05）；IL-10分别与圳）、LVDs、LVDd、IVST、LVWPT、LVMI呈负相关（P〈0．05），与LVEF呈正相关（P〈0．05）。老年MHD组LAD、LVPWT、IVST、LVMI水平显著高于中年组（P〈0．05），而LVEF显著低于中年组（P〈0．05）。结论：MHD患者存在微炎症状态，与心室重塑的发生和发展有关，老年MHD患者尤为显著。

Relationship between Relevant Factors of Micro-inlanmmantionary State and Left Ventricular Remodeling in Senile MHD Patients

Objective：To investigate the relationship of cardiac structure and function and the indexes of serum CRP, IL- 1, IL-6, IL- 10,TNF-α,Alb and in MHD patients respectively. Aslo we discussed the relationship of relevant factors of micro- inflammationary state in MHD patients and left ventricular remodeling. Methods： 30 senile MHD cases, 30 middle - aged MHD cases were enrolled and 28 healthy adults were recruited as control group. Serum CRP, IL - 1, IL - 6, IL - 10, TNF-α and Alb of them were determined. LAD, LVDd, LVDs, IVST, LVPWT, LVEF and LVMI were measured by echocardiogram. The cardiac/chest ratio was figured out by X - ray chest film. Results：The indexes of CRP, IL - 1, IL - 6, IL- 10,TNF-α in MHD cases were higher than those in control group （P〈0.05）. LAD, LVDd, LVDs, IVST and LVWPT in MHD cases were notably higher than those in control group （P〈 0.05）. Compared with those of control group, Alb and LVEF of MHD patients were manifestly lower （P 〈 0.05）, and LVMI of MHD group strikingly higher（P〈0.01 ）. CRP, IL - 1, IL- 6, IL - 10 and TNF-α were positively correlated with LAD, LVDs, LVIM, IVST, LVWPT and LVMI respectively （ P 〈 0.05 ）, and negatively correlated with LVEF （P〈0.05）. LAD, LVPWT, IVST and LVMI in .senile MHD group were significantly higher than those in middle - aged MHD group, and LVEF in senile MHD group obviously lower（P〈 0.05）. Conclusion： Existing micro- inflammatory state in MHD is associated with the genesis and development of ventricular remodeling, especially in senile MHD.