维持性血液透析患者炎性反应因子水平与左心室结构和功能的关系

 目的 观察维持性血液透析(maintenace hemodialysis,MHD)患者体内高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)浓度的变化,探讨MHD患者微炎性反应状态对左心室结构和功能的影响.方法 选择MHD患者60例作为血液透析组,选取20例诊断为慢性肾功能不全尿毒症期,非透析患者作为非透析组,检测两组血IL-6 、TNF-α、hs-CRP、尿素氮(BUN)、肌酐(SCr)水平;用二维彩色多普勒超声显像仪测定心脏LAD、LVDs、IVST、LVPWT、LVEF,并计算LVMI,分析hs-CRP与左心室结构和功能变化的关系.结果 ⑴透析组患者血清hs-CRP、IL-6、TNF-α水平均高于非透析组,差异有统计学意义(P<0.05);⑵透析组LAD、LVDs 、IVST、LVPWT、LVMI检测值均高于非透析组,LVEF低于非透析组,差异有统计学意义(P<0.05);⑶MHD患者血清hs-CRP与LAD、LVDs 、IVST 、LVPWT、LVMI呈正相关(P<0.05),与LVEF呈负相关(P<0.05).结论 MHD不能改善微炎性反应状态,治疗过程本身还会促进、加重微炎性反应;微炎性反应状态在MHD患者左心室结构和功能损害中发挥了重要作用.

Relationship between inflammatory factors and left ventricular structure and function in maintenance hemodialysis patients

Objective To study the changes in serum levels of hs - CRP,IL -6 and TNF -αin maintenance hemodialysis patients,to measure the indicators of structure and function of left ventricle by echocardiography,and to investigate the effects of micro-inflammatory reaction on left ventricular structure and function in maintenance hemodialysis patients.Method Sixty patients with uremia undergoing maintenance hemodialysis were selected as MHD group.And 20 non - dialysis patients with uremia were recruited as the control group.The serum hs - CRP,IL -6,TNF -αBUN and Cr were assayed in the MHD group and the control group.Two - dimensional color Doppler echocardiography was used to measure LAD,LVDs,IVST,LVPWT,and LVEF,calculating LVMI,analyzing the relationship between the serum level of hs - CRP and the changes in left ventricular structure and function.Results(1) The serum levels of hs - CRP,IL - 6,and TNF -αin the MHD group were higher than those in the control group;the difference was statistically significant(P<0.05).(2)LAD,LVDs,IVST,LVPWT,and LVMI in the MHD group were higher than those in the control group,while the LVEF was lower than that in the control group(P<0.01);the difference was statistically significant P<0.05 ).(3)The correlation analysis indicated that hs -CRP and LAD,LVDs,IVST,LVPWT,and LVMI in MHD patients were negatively interrelated(P<0. 05),while hs - CRP and LVEF were positively interrelated(P<0.05).Conclusions Maintenance hemodialysis does not improve microinflammatory state,and treatment process itself also boosts and increases microinflammation.