维持性血液透析患者慢性炎症与心脏结构和功能关系的研究

目的探讨维持性血液透析（maintenancehemodialySiS，MHD）患者血清中炎性因子水平与患者心脏结构及功能变化的关系。方法酶联免疫法检测患者血清超敏C反应蛋白（hsCRP）、白介素6（IL一6）、肿瘤坏死因子a（TNF—n）的水平及血生化指标，并根据hs—CRP水平将患者分为升高组（hsCRP≥3mg／L）及正常组（hsCRP〈3mg／L）；彩色多普勒超声诊断仪测定2组患者左心房前后径（LAD）、左心室舒张期内径（LVDd）、左心室收缩期内径（LVDS）、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）、左心室射血分数（LVEF）、二尖瓣前向血流E峰与A峰比值（E／A），测量心排出量（CO）；并观察2组间心脏结构、功能和血清炎症因子的变化及其相关性的分析。结果hsCRP升高组患者的胆固醇及三酰甘油水平较正常组无明显差异（P〉0．05），而白蛋白水平较正常组低（t=2．514，P〈0．05）；hsCRP升高组患者LAD、LVDd、LVDs、LVPWT、IVST和LVMI均高于hsCRP正常组（P〈0．05），hsCRP升高组LVEF、E／A和cO低于hsCRP正常组（P〈0．01）；hsCRP升高组左心室肥厚、左心室收缩功能减退及左心室顺应性下降发生率均高于hsCRP正常组（P〈0．01）；血清炎症因子与心超指标的相关性分析发现：hsCRP、IL6、TNF一Ⅱ分别与LAD、LVDd、LVDs、LVPWT、IVST、LVMI呈正相关hsCRP、IL6、TNF—a分别与LVEF、E／A、CO呈负相关。结论MHD患者血清中炎性因子水平与患者心脏结构及功能变化相关。

Investigation on the relationship between chronic inflammation and cardiac structure and function in maintenance hemodialysis patients

Objective To investigate the relationship between serum inflammation factors and cardiac structure and function in maintenance hemodialysis （MHD） patients. Methods Serum hsCRP, IL-6 and TNF- a were measured by enzyme linked immunosorbent assay （ELISA）. We then assigned the MHD patients into normal hsCRP group and abnormal hsCRP group （hsCRP higher than normal level）. Doppler ultrasonography was used to determine LAD, LVDd, LVDs, LVPWT, IVST LVMI, LVEF, E/A, and CO in the two groups of MHD patients. The changes of cardiac structure and function were analyzed in correlation to the changes of serum inflammation factors. Results In the abnormal hsCRP group, serum cholesterol and triglyceride were similar to those in the normal hsCRP group （P 〉 0.05）, but serum albumin was lower than that in the normal hsCRP group （t=2.514, P 〈 0.05）; LAD, LVDd, LVDs, LVPWT, 1VST and LVMI were higher （P ~ 0.05）, but LVEE E/A and CO were lower （P 〈 0.01） than those in the normal hsCRP group. The prevalence of left ventrieular dysfunction including hypertrophy, hypo-contractility and lower ventricular compliance was higher in the abnormal hsCRP group than in the normal hsCRP group （P 〈 0.01）. Correlation analyses demonstrated that the serum inflammation factors ofhsCRP, IL6 and TNF-ct were positively correlated to LAD, LVDd, LVDs, LVPWT, IVST and LVMI, and were negatively correlated to LVEE E/A and CO. Conclusion Serum inflamma- tion factors are correlated to cardiac structure and function in MHD patients.