慢性肾衰竭患者血清sCD40L与动脉粥样硬化的关系

目的：研究慢性肾衰竭患者血清sCD40L水平与动脉粥样硬化的关系。方法：选择慢性肾衰竭患者60例和健康对照34例，采用酶联免疫吸附法测定血清sCD40L水平，用高分辨超声技术检测颈总动脉内膜一中层厚度（IMT）、粥样硬化斑块以及反应性充血后和舍服硝酸甘油后肱动脉内径的变化率。结果：慢性肾衰竭患者血清sCD40L水平高于正常对照组（P〈0．05）；慢性肾衰竭患者IMT和颈总动脉粥样斑块检出率均高于正常对照组（P〈0．05）；肱动脉反应性充血后内径增加率（Dh）、舍服硝酸甘油后内径增加率（Dn）均分别低于正常对照组Dh和Dn（P〈0．05）；按动脉粥样硬化严重程度分级，病变越严重者血清sCD40L水平越高。结论：慢性肾衰竭患者动脉粥样硬化与血清sCD40L水平有关，提示sCD40L是CRF患者动脉粥样硬化发生、发展的危险因素。

Relationship between serum sCD40L and atherosclerosis in patients with chronic renal failure

Objective To investigate the relationship between serum sCD40L and atherosclerosis in patients with chronic renal failure. Methods Sixty chronic renal failure patients and 34 healthy volunteers were included in this study. Serum sCD40L was measured with enzyme-linked immunosorbent assay. Intima-media thickness (IMT) and prevalence atherosclerotic plaques of the extracranial common carotid artery were determined with high-resolution B-mode ultrasonography. The changes in brachial artery diameter during reactive hyperemia(Dh) and after administration of sublingual nitroglycerin (Dn) were analyzed during ultrasonic examination. Results The mean level of sCD40L was significantly higher in the chronic renal failure patients than that in the healthy cotrols (P<0.05). The prevalence of atherosclerotic plaques and the mean intima-media thickness value of carotid artery were significantly increased in chronic renal failure patients compared with that in age-matched controls (P<0.05). Furthermore, arterial dilating function such as Dh and Dn was significantly decreased in chronic renal failure patients compared with that in controls(P<0.05). The levels of serum sCD40L were coherent with intensity of atherosclerosis in the chronic renal failure patients. Conclusion It is indicated that atherosclerosis in chronic renal failure patients is associated with the increase of serum sCD40L level. sCD40L may be an independent risk factor for atherosclerosis in chronic renal failure patients.