血液透析患者动静脉内瘘血流量与机体炎症因子水平相关性分析

目的 探讨血液透析（hemodialysis,HD）患者动静脉内瘘血流量（arteriovenous fistula blood flow,AVFB）与机体炎症因子水平的关系,并分析AVFB对心血管发病率的影响. 方法 选取2012年1～6月在山东省潍坊市益都中心医院血液净化中心以自体动静脉内瘘为HD通路的患者45例（HD组）,并选择同期门诊健康体检者26例为对照组.采用透析监测仪监测AVFB.HD组在监测AVFB前取透析前血标本,对照组血标本取自门诊健康体检者.采用ELISA法检测C反应蛋白（c-reactive protein,CRP）、肿瘤坏死因子（tumor necrosis factor,TNF）及白介素-6（interleukin-6,IL-6）水平.对患者随访12个月,并记录心血管疾病发生情况. 结果 血液透析前,HD组CRP、TNF及IL-6水平分别为（4.85±1.32） mg/L、（1.29±0.14） ng/L和（2.41±0.55） ng/L,显著高于对照组的（1.49±0.27） mg/L、（0.56±0.33） ng/L和（1.17±0.16） ng/L,差异均有统计学意义（P＜0.05）.随访12个月内,共10例（22.22％）患者发生心血管疾病,且发生心血管疾病患者CRP、IL-6水平均显著高于未发生者（P＜0.05）.Logistic回归分析表明,IL-6是心血管疾病的独立危险因素;spearman相关分析表明,AVFB与IL-6呈正相关;线性回归分析显示,当AVFB大于1067.25ml/min时,HD患者心血管发病率较高.结论 动静脉内瘘血流量与IL-6呈正相关,且动静脉内瘘高血流量可能通过IL-6而参与心血管疾病的发生.

Correlation analyses between blood flow in arteriovenous fistula and levels of inflammatory factors in hemodialysis patients

Objective To discuss the relationship between blood flow in arteriovenous fistula （AVFB）and levels of inflammatory factors,and to analyze the effect of AVFB on cardiovascular morbidity in hemodialysis （HD） patients.Methods A total of 45 HD with autologous arteriovenous fistula treated in the blood purification center of our hospital during Jan.to Jun.2012 were recruited in this study （HD group）.AVFB was measured during dialysis by the dialysis monitor.Blood samples were obtained from HD patients before the dialysis session and from 26 healthy individuals as the control group.Serum CRP,TNF and IL-6 were measured by ELISA.Patients were followed up for cardiovascular disease for 12 months.Results Serum CRP,TNF and IL-6 was 4.85±1.32 mg/L,1.29±0.14 ng/L,and 2.41±0.55 ng/L,respectively,in HD group before dialysis,and was 1.49±0.27 mg/L,0.56±0.33 ng/L and 1.17±0.16 ng/L,respectively,in control group,significantly higher in HD group than those in control group （P＜0.05）.During the follow-up period of 12 months,cardiovascular disease was found in 10 cases （22.22％）,in which serum CRP and IL-6 were significantly high-er than those in the cases without cardiovascular disease （P＜0.05）.Logistic regression analysis showed that IL-6 was the independent risk factor for cardiovascular disease.Spearman correlation analysis demonstrated that AVFB was positively correlated with IL-6.Linear regression analysis indicated that the prevalence of cardiovascular disease increased when AVFB was ＞1067.25 ml/min.Conclusion AVFB was positively correlated with serum IL-6,and higher AVFB may be involved in the pathogenesis of cardiovascular disease through its effect on IL-6 level.