血液透析患者颈动脉内中膜厚度与血清高敏C反应蛋白、成纤维细胞生长因子23和klotho蛋白的相关性研究

目的 了解维持性血液透析（maintenance hemodialysis,MHD）患者颈动脉粥样硬化情况,分析该人群颈动脉内中膜厚度（carotid intima-media thickness,CIMT）与血清高敏C反应蛋白（HsCRP）、成纤维细胞生长因子23（fibroblast growth factor 23,FGF23）及Klotho蛋白水平之间的相关性.方法 选取2012年1月至6月期间在卫生部北京医院血液净化中心MHD患者共88例,根据颈动脉彩色多普勒超声检查结果分为CIMT增厚组和CIMT正常组.对CIMT增厚可能的危险因素进行分析,采用非条件Logistic回归分析进行CIMT影响因素的多因素分析.结果 88例MHD患者中CIMT增厚者共53例（60.2％）,CIMT正常者共35例（39.8％）,2组CIMT中位数分别为1.5mm和1.0mm,有统计学意义（P=0.000）.其中CIMT增厚组粥样硬化斑块发生率明显高于CIMT正常组（92.5％比65.7％,P=0.001）.CIMT增厚组平均年龄为66.64±10.61岁,CIMT正常组平均年龄为58.63±11.78岁,有统计学意义（t=3.320,P=0.001）;CIMT增厚组糖尿病患病率为37.7％,CIMT正常组糖尿病患病率为17.1％,有统计学意义（x2=4.294,P=0.038）;CIMT增厚组与正常组FGF23中位数分别为127.82 ng/L和86.74 ng/L有统计学意义（Z=-3.713,P=0.000）;2组HsCRP中位数分别为5.34mg/L和2.19mg/L,有统计学意义（Z=-3.547,P=0.000）.CIMT增厚组与正常组Klotho蛋白中位数分别为42.48 U/L和41.21U/L,2组无统计学意义（Z=-0.085,P=0.932）.非条件Logistic回归分析显示年龄、FGF23和HsCRP是CIMT增厚的独立危险因素.结论 MHD患者伴CIMT增厚者易形成动脉粥样硬化斑块.血清HsCRP、FGF23和年龄是MHD患者CIMT增厚的独立危险因素.

Studies on the relationship between carotid intima-media thickness and serum levels of hsCRP,FGF23 and Klotho protein in maintenance hemodialysis patients

Objctive To understand the clinic features of carotid artery atherosclerosis in maintenance hemodialysis （MHD） patients,and to analyze the relationship between carotid intima-media thickness （CIMT）and serum levels of high sensitive C-reactive protein （hsCRP）,fibroblast growth factor 23 （FGF23）,and Klotho protein.Methods Eighty-eight MHD patients treated in the Blood Purification Center of Beijing Hospital from January to June 2012 were enrolled in this study.The patients were divided into increased CIMT group and normal CIMT group based on their carotid color Doppler ultrasound results.Possible risk factors for increased CIMT including age,were analyzed and compared between the two groups.Non-conditional logistic regression was used for multivariate analysis to determine the risk factors for the increase of CIMT.Results There were 53 patients （60.2％） in increased CIMT group and 35 patients （39.8％） in normal CIMT group.The median value of CIMT was 1.5mm and 1.0mm in increased CIMT group and normal CIMT group,respectively （P=0.000）.The prevalence of atherosclerotic plaque was significantly higher in increased CIMT group （92.5％） than in normal CIMT group （65.7％,P=0.001）.Univariate analysis indicated that the average age was 66.64± 10.61 years in increased CIMT group,and was 58.63 ± 11.78 years in normal CIMT group （t=3.320,P=0.001）.The prevalence of diabetes was 37.7％ in increased group,and was 17.1％ in normal CIMT group （x2=4.294,P=0.038）.The median value of FGF23 was 127.82 ng/L in increased CIMT group and 86.74 ng/L in normal CIMT group （Z=-3.713,P=0.000）.The median value of hsCRP was 5.34 mg/L in increased CIMT group and 2.19 mg/L in normal CIMT group （Z=-3.547,P=0.000）.The median value of Klotho protein was 42.48 U/L in increased CIMT group and 41.21 U/L in normal CIMT group （Z=-0.085,P=0.932）.Non-conditional logistic regression analysis showed that age,FGF23 and hsCRP were the independent risk factors for increase of CIMT in MHD patients.Conclusion MHD patients with increased CIMT are more likely to have atherosclerosis plaque.Serum hsCRP,FGF23 and age are the independent risk factors for increase of CIMT in MHD patients.