慢性肾脏病患者血清脂肪细胞因子水平及其作用的研究

目的检测慢性肾脏病（CKD）患者血清脂联素（ADPN）、抵抗素（Res）、肿瘤坏死因子-α（TNF-α）、超敏C反应蛋白（hs-CRP）水平,探讨CKD患者血清脂肪细胞因子水平的变化及其作用。方法选择CKD患者104例,分为肾病组、肾炎组、肾衰非透析组、腹膜透析组和血液透析组。另设健康对照组。用ELISA方法检测上述各项指标,比较各组间的差别。结果①CKD患者血清ADPN水平在肾病组（22.40±6.02）mg/L]、肾炎组（12.41±4.01）mg/L]、肾衰非透析组（15.88±4.94）mg/L]、腹膜透析组（14.55±3.51）mg/L]和血液透析组（14.26±4.54）mg/L]均显著升高（与对照组（4.95±2.19）mg/L]相比,P＆lt;0.01）,并以肾病组升高为著;②患者的血清Res水平在肾衰非透析组（9.95±2.65）μg/L]、腹膜透析组（10.9±2.55）μg/L]和血液透析组（10.52±4.77）μg/L]均显著升高（与对照组（4.60±1.47）μg/L]和肾病组（5.80±2.16）μg/L]、肾炎组（5.57±1.24）μg/L]患者相比,P〈0．01）；③cKD患者的血清ADPN水平与Res、尿蛋白量呈正相关（P〈0．05），与血白蛋白水平呈负相关（P〈O．01）；血清Res水平与TNF一α、hs-CRP、血肌酐呈正相关（P〈0．01），与肾小球滤过率呈负相关（P〈0．01）。结论CKD患者的血清ADPN、Res水平显著升高，并与尿蛋白量、炎性因子和肾小球滤过率等因素有关。ADPN和Res在CKD患者动脉粥样硬化的启动和发展中可能起一定作用。

The level and role of serum adipokines in patients with chronic kidney disease

Objective To examine the levels of serum adipokines in patients with chronic kidney disease（CKD）, and identify the relationship between serum adipokines and tumor necrosis factor （TNF）-α, high sensitivity C-reactive protein（ hs-CRP） and renal function. Methods 104 CKD patients and 20 normal healthy persons were involvled in this study. The patients were divided into five groups ： patients with nephrotic syndrome （NS）, non-nephrotic syndrome（ n-NS）, chronic renal failure （CRF）, peritoneal dialysis （PD）and hemodialysis （HD）. The levels of serum adiponeetin （ADPN） , resistin （ Res）, TNF-α and hs-CRP were detected by means of ELISA. Differences in continuous variables between the six groups were evaluated. Results （1）The levels of serum ADPN were signifieantly higher in group of NS （ 22.40±6. 02 ） mg/L], n-NS （ 12.41 ±4.01 ） mg/L], CRF （ 15.88 ±4. 94） mg/L] ,PD （ 14. 55 ±3.51 ） mg/L] and HD （ 14.26±4. 54） mg/L] patients than those in control group （4. 95 ±2. 19 ）mg/L1 （P 〈 0. 01 ） ; （2）The levels of serum Res were significantly higher in group of CRF （9. 95 ± 2.65 ） Ixg/L], PD （ 10. 90± 2. 55 ）μg/L] and HD （ 10.52 ± 4. 77 ） μg/L] than those in healthy subjects （4. 60 ± 1.47） μg,/L] ,NS （5.80 ＋2. 16） Ixg,/L] and n-NS （5.57 ± 1.24） μg/L] （P 〈 0. 01 ） ;（3）Serum ADPN levels in CKD patients were positively related to serum Res level（ r =0. 247 ,P 〈0. 05 ） and urinary protein excretion amount （ r = 0. 819, P 〈 0. 01 ）, and negatively related to serum albumin （ r = - 0. 686, P 〈 0. 01 ） ;（4）Serum Res levels in CKD patients were positively related to serum TNF-α （r = 0. 736） , hs- CRP（ r = 0. 619 ） and SCr（ r = 0. 641 ） （ P 〈 0. 01 ）, and negatively related to eGFR（ r = -0. 615, P 〈 0. 01 ）. Conclusion The levels of serum ADPN and Res were markedly increased in patients with CKD, and correlated with urinary protein excretion amount, serum TNF-α and hs-CRP level, and renal function. In addition, the study suggested ADPN and Res might play a role in artherosclerosis associated with CKD.