维持性血液透析患者微炎症与心室结构和功能及预后的相关研究

目的分析超敏C反应蛋白（hsCRP）、白细胞介素6（IL-6）和肿瘤坏死因子α（TNF-α）对维持性血液透析（MHD）患者心脏结构和功能的影响。方法选择MHD患者97例,病情稳定,已排除急性感染及其他活动性疾病。根据hsCRP检测的水平分为hsCRP升高组（hsCRP≥3 mg/L）和hsCRP正常组（hsCRP〈3 mg/L）,分别观察患者的炎症因子TNF-α、IL-6和hsCRP,并应用心脏超声心动图测定患者左心房前后径（LAD）、左心室舒张期内径（LVEDd）、左心室收缩期内径（LVEDs）、左心室舒张期后壁厚度（LVPWT）、室间隔厚度（IVST）、左心室质量指数（LVMI）和左心室射血分数（LVEF）、二尖瓣前向血流E峰与A峰比值（E/A）、心排出量（CO）等。结果 MHD患者hsCRP升高组与hsCRP正常组的血清hsCRP分别为（8.09±3.58）mg/L vs（2.06±0.56）mg/L,IL-6分别为（112.2±43.47）ng/L vs（83.3±26.79）ng/L,TNF-α分别为（5.09±2.21）μg/L vs（4.16±1.64）μg/L（P〈0.05或〈0.01）。hsCRP升高组LAD、LVEDd、LVEDs、LVPWT、IVST、LVMI均高于hsCRP正常组（P〈0.01）,hsCRP升高组LVEF,E/A,CO低于hsCRP正常组（均P〈0.01）。hsCRP升高组hsCRP、IL-6、TNF-α分别与LAD、LVEDd、LVEDsI、VST、LVPWT、LVMI呈正相关（P〈0.05或〈0.01）,与LVEF、E/A、CO呈负相关（P〈0.05）。hsCRP与TNF-αI、L-6相互之间呈正相关（均P〈0.01）。结论 MHD患者存在微炎症状态,并且参与了心脏结构和功能的改变。

Microinflammatory state correlates cardiac structure and fuction in patients with maintenance hemodialysis

Objective To investigate the effects of high sensitive C-reactive protein（hsCRP）,interleukin 6（IL-6） and tumor necrosis factor α（TNF-α） on the cardiac structure and fuction in patients with maintenance hemodialysis.Methods The selection included 97 patients with maintenance hemodialysis who had undergone hemodialysis for more than three months and were in a stable clinic status without signs of acute infections or other progressive diseases.These patients were divided into elevated hsCRP group（hsCRP≥3 mg/L）and normal hsCRP group（hsCRP3 mg/L）.Serum TNF-α,IL-6 and hsCRP were measured.The left atrial diameter（LAD）,left ventricular end-diastolic diameter（LVEDd）,left ventricular end-diastolic dimension（LVEDs）,interventricular septal thickness（IVST）,left ventricular posterior wall thickness（LVPWT） and left ventricular ejection fraction（LVEF）,left ventricular mass index（LVMI）,ratio of E/A,the cardiac output（CO） were measured by ultrasonic cardiography.Results TNF-α,IL-6 and hsCRP concentrations were significantly higher in elevated hsCRP group than those in normal hsCRP group,hsCRP（8.09±3.58） mg/L vs（2.06±0.56） mg/L,IL-6（112.2±43.47） ng/L vs（83.3±26.79） ng/L,TNF-α（5.09±2.21） μg/L vs（4.16±1.64） μg/L（P〈0.05 or 0.01）.LAD,LVEDd,LVEDs,LVPWT,IVST and LVMI increased significantly（P〈0.01）,while LVEF,E/A and CO decreased markedly（P〈0.01）.In patients with maintenance hemodialysis,the average serum hsCRP,IL-6 and TNF-α were positively correlated with the values of LAD,LVEDd,LVEDs,IVST,LVPWT and LVMI（P〈0.05 or 0.01）,but negatively correlated with the value of LVEF,E/A and CO（P〈0.01）.Serum hsCRP was positively correlated with IL-6 and TNF-α（both P〈0.01）.Conclusion The inflammatory factors are probably involved in the presence and progression of heart structure and its function in patients with maintenance hemodialysis.