带cuff导管血液透析患者微炎症状态、氧化应激与颈动脉硬化的关系

目的探讨带cuff导管的维持性血液透析（MHD）患者微炎症状态、氧化应激对颈动脉内中膜厚度（IMT）的影响。方法选择MHD患者54例，其中带cuff导管血液透析患者24例为导管组，内瘘透析患者30例为内瘘组，另设健康志愿者30名为对照组。测定所有患者C反应蛋白（CRP）、血浆丙二醛（MDA）、超氧化物歧化酶（SOD）、血沉、血红蛋白（Hb）、血白细胞（WBC）及生化等指标。采用多元逐步回归法分析IMT与各指标间，CRP与血浆丙二醛（MDA）、SOD、血浆谷胱甘肽过氧化物酶（GSH-PxD）间的相关性。结果导管组CRP、MDA、SOD、GSH-Px、IMT与内瘘组差异非常显著（P〈0．01）。回归分析CRP与SOD（t：一2．299，P〈0．026）、MDA（t=4．055，P〈0．001）、GSH-Px（t=一2．887，P〈0．006）相关。IMT与CRP相关（t=7．353，Pd0．001）。结论导管组存在明显炎症、氧化应激，炎症与氧化应激相关，CRP与颈动脉硬化相关。

Relationship of carotid artery atherosclerotic plaque with microinflammatory state and oxidative stress inMHD patients with tunneled cuffed catheter

Objective To study the effects of microinflammatory state and oxidative stress in maintenance hemodialysis （MHD） patients with cuffed dual-lumen catheter through subcutaneous tun- nel on the intimal medial thickness （IMT） of the carotid artery. Methods Fifty-four MHD patients with hemodialysis more than two years were enrolled and divided into the catheter group（24 cases） and the arteriovenous fistula group （30 cases）. Thirty healthy volunteers served as the control group. The levels of C-reactive protein （CRP）, malondialdehyde （MDA）, superoxide dismutase （SOD） and gluta- thione peroxidase （GSH-Px）, leukocytes, ESR, hemoglobin and IMT were measured in whole pa- tients. The multiple stepwise regression was done to analyze the correlation of IMT in the carotid arter- y with CRP,MDA,SOD,GSH-Px and Alb,and CRP with MDA,SOD and GSH-Px. Results The lev- els of CRP, MDA, SOD,GSH-Px and IMT were significantly higher in catheter group than in control group （P~0. 01 ）. The CRP was independently correlated with SOD （t = - 2. 299, P〈0. 026）, MDA （t = 4. 055,P〈0. 001）, GSH-Px （t = - 2. 887, P〈0. 006）. The IMT in the carotid artery was inde- pendently correlated with CRP （t = 7. 353,P〈0. 001）. Concl~ions There existed mieroinflammatory state and oxidative stress in MHD patients with cuffed catheter. The mieroinflammatory state is corre- lated with oxidative stress, and the CRP is correlated with carotid artery atherosclerotie plaque.