维持性血液透析患者血浆apelin水平与颈动脉粥样硬化的关系

目的：探讨维持性血液透析(maintenance hemodialysis，MHD)患者血浆脂肪细胞因子apelin的水平及其与颈动脉粥样硬化的关系。方法：以92例MHD患者为研究对象，36例年龄和性别相匹配者作为健康对照组。采用放射免疫测定法检测血浆apelin水平；ELISA法检测血清内皮细胞损伤标志物血栓调节蛋白(thrombomodulin)、血管性血友病因子(von Willebrand factor，vWF)、CD146水平和炎症因子超敏C反应蛋白(hsCRP)、IL-6和TNF-α水平；高分辨超声技术测定颈总动脉内膜-中层厚度(common carotid artery intima and media thickness，CCA-IMT)，切面内膜中层面积(cross-sectional calculated intima-media area，cIM area)及粥样硬化斑块。结果：MHD组患者血浆apelin水平明显低于健康对照组(P<0.01)，伴随血清thrombomodulin，vWF，CD146，hsCRP，IL-6和TNF-α明显升高(均P<0.01)。颈动脉有斑块的MHD患者血浆apelin低于无斑块者[(43.16±10.12) pg/mL vs (61.43±16.25) pg/mL，P<0.01]。MHD组患者血浆apelin浓度与CCA-IMT，cIM area呈负相关(r分别为–0.355和–0.297，均P<0.01)。多元逐步回归分析结果显示血浆apelin是CCA-IMT和cIM area的独立危险因素。结论：MHD患者血浆apelin水平明显降低，其可能通过促进hsCRP，IL-6，TNF-α等炎症因子的产生，参与血管内皮损伤和动脉粥样硬化的进展，并在尿毒症相关动脉粥样硬化的启动与发展中起一定作用。

Plasma level of apelin and carotid atherosclerosis inmaintenance hemodialysis patients

Objective: To determine the plasma level of apelin in patients of maintenance hemodialysis (MHD) and to explore the relationship between apelin level and carotid atherosclerosis (AS) in MHD patients.Methods: A total of 92 MHD patients and 36 sex- and age-matched healthy subjects were enrolledin this study. Th e plasma level of apelin was evaluated by radiation immunoassay; serum endothelialinjury markers including thrombomodulin, von Willebrand factor (vWF), and CD146, andinflammatory factors including high sensitive C-reactive protein (hsCRP), IL-6 and TNF-α weredetermined by ELISA. Common Carotid arteries intima media thickness (CCA-IMT), crosssectionalcalculated intima-media area (cIM area) area and atherosclerotic plaque were measured bynon-invasive high-resolution B-mode ultrasonography.Results: The plasma levels of apelin was significantly decreased in MHD patients compared withhealthy subjects (P<0.01), accompanied with elevated plasma levels of thrombomodulin, vWF,CD146, hsCRP, IL-6 and TNF-α (all P<0.01). The plasma levels of apelinin in MHD patients withcarotid artery plaques were obviously lower than those without plaques [(43.16±10.12) pg/mL vs(61.43±16.25) pg/mL, P<0.01]. Plasma level of apelin was inversely related with CCA-IMT andcIM area (r=–0.355 and r=–0.297 respectively, all P<0.01). Multiple stepwise regression analysisshowed that plasma level of apelin was an independent risk factor for CCA-IMT and cIM area.Conclusion: The plasma apelin in MHD patients might take part in vascular endothelial injuryand the progress of atherosclerosis. It plays an important role in the initiation and development ofuremia associated atherosclerosis through elevating inflammatory factors including hsCRP, IL-6and TNF-α levels.