【摘要】：背景： 近年來，隨著對慢性腎臟病（chronic kidney disease，CKD）發(fā)病機(jī)制及其并發(fā)癥研究的深入,微炎癥狀態(tài)引起了人們的重視。微炎癥狀態(tài)（microinflammatory state），是指非微生物感染引起的血液循環(huán)中細(xì)胞因子及正性時相反應(yīng)蛋白輕度持續(xù)升高，并能夠促進(jìn)患者腎功能惡化及并發(fā)癥發(fā)生的慢性非顯性炎癥狀態(tài)[1]。C反應(yīng)蛋白（CRP）是正性時相反應(yīng)蛋白之一,CRP低水平持續(xù)升高，但不超過10-15mg/L是微炎癥狀態(tài)的標(biāo)志。隨著實(shí)驗(yàn)方法學(xué)的不斷改進(jìn)，超敏C-反應(yīng)蛋白（hs-CRP）可以檢測出低水平的CRP濃度，更早、更好反應(yīng)CKD患者的微炎癥狀態(tài)反應(yīng)微炎癥狀態(tài)，健康人的hs-CRP小于3mg/L,當(dāng)其超過3mg/L，即使的臨床感染癥狀不明顯，也代表機(jī)體存在感染時相的病理反應(yīng)過程。CKD患者體內(nèi)普遍存在微炎癥狀態(tài)，微炎癥程度在一定程度上提示CKD患者的預(yù)后。因此，明確CKD患者微炎癥狀態(tài)發(fā)生機(jī)制，對其做到早期檢測和干預(yù)，有助于提高患者的生存質(zhì)量，降低病死率。 目的： 研究慢性腎臟病患者微炎癥狀態(tài)相關(guān)影響因素 方法： 該研究選擇2012年1月~2013年1月吉林大學(xué)第一醫(yī)院腎病科住院患者199例，根據(jù)其血清超敏C-反應(yīng)蛋白（hs-CRP）值分為微炎癥狀態(tài)組（hs-CRP＞3mg/L）和正常組（hs-CRP≤3mg/L），其中微炎癥狀態(tài)組100人，正常組99人。分別對兩組中患者的年齡、性別、原發(fā)病、血壓（BP)、血肌酐（Scr）、血紅蛋白（Hb）、甘油三酯(TG)、膽固醇(TC)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、血白蛋白（Alb）等一般臨床資料和生化指標(biāo)以及左室射血分?jǐn)?shù)（EF）、左室舒張末期內(nèi)徑（LVDd）、室間隔厚度（IVST）進(jìn)行比較分析。采用SPSS19.0軟件進(jìn)行資料數(shù)據(jù)統(tǒng)計。正態(tài)或近似正態(tài)分布的計量資料以(x±s)表示，兩樣本均數(shù)比較采用獨(dú)立樣本的t檢驗(yàn)；偏態(tài)分布的計量資料采用中位數(shù)(下四分位數(shù)-上四分位數(shù))表示，采用秩和檢驗(yàn)進(jìn)行組間比較；計數(shù)資料進(jìn)行χ2檢驗(yàn)。采用直線相關(guān)分析(Pearson相關(guān)分析)對各資料相關(guān)性進(jìn)行分析，P0.05有統(tǒng)計學(xué)意義。 結(jié)果： 1.一般臨床資料：199例CKD患者中，，男性112例，女性87例。原發(fā)病中以原發(fā)性腎小球疾病為主，共97例（45.73%），其次為糖尿病腎病55例（27.64%）、高血壓腎病37例（18.59%）、多囊腎8例（4.02%）、慢性間質(zhì)性腎炎6例（3.02%）、梗阻性腎病1例（0.5%）、其他1例（0.5%）。微炎癥狀態(tài)組100例（50.25%），正常組99例（49.75%）。微炎癥狀態(tài)組患者透析齡大于正常組，差異有統(tǒng)計學(xué)意義（P＜0.05）。各組原發(fā)病比較、收縮壓及舒張壓比較差異均無統(tǒng)計學(xué)意義（P＞0.05）。 2.生化指標(biāo)以及心臟結(jié)構(gòu)和功能指標(biāo)：與正常組比較，微炎癥狀態(tài)組Scr、LVDd升高，差異有統(tǒng)計學(xué)意義（P＜0.05）。Hb、Hct、TP、Alb、TC、LDL-C、EF降低，差異有統(tǒng)計學(xué)意義（P＜0.05）。兩組間血pr-Alb、TG、HDL-C、ApoA水平差異無統(tǒng)計學(xué)意義（P＞0.05）。兩組間IVST比較差異無統(tǒng)計學(xué)意義（P＞0.05）。 3.相關(guān)關(guān)系：hs-CRP與Scr、BUN，LVSd之間呈正相關(guān)（P＜0.05）。與Hb、Hct、TP、Alb、EF呈負(fù)相關(guān)。 結(jié)論： 1、CKD患者中并發(fā)微炎癥狀態(tài)的占50.25%，隨著腎功能的減退微炎癥狀態(tài)加重，微炎癥狀態(tài)可以促進(jìn)腎功能惡化。 2、微炎癥狀態(tài)可能促進(jìn)貧血、營養(yǎng)不良、心功能不全等并發(fā)癥的發(fā)生、發(fā)展。
[Abstract]:Background:
In recent years, with the in-depth study of the pathogenesis and complications of chronic kidney disease (CKD), Micro-inflammatory State has attracted much attention. Microinflammatory state refers to the slight and sustained increase of cytokines and positive phase reaction proteins in the blood circulation caused by non-microbial infection. Chronic nondominant inflammatory state that can promote renal function deterioration and complications [1]. C-reactive protein (CRP) is one of the positive phase reaction proteins. Low CRP levels continue to rise, but no more than 10-15mg/L is a marker of microinflammatory state. With the continuous improvement of experimental methodology, hypersensitive C-reactive protein (hs-CRP) can detect low levels. CRP concentration, earlier and better responded to the microinflammatory state of CKD patients, hs-CRP in healthy people was less than 3mg/L, when it was more than 3mg/L, even if the clinical infection symptoms were not obvious, it also represented the pathological reaction process of the body at the time of infection. Therefore, it is helpful to improve the quality of life and reduce the mortality of patients with CKD to clarify the pathogenesis of microinflammation in patients with CKD and to detect and intervene early.
Objective:
Factors related to micro inflammation in patients with chronic kidney disease
Method:
In this study, 199 inpatients in the Department of Nephrology, First Hospital of Jilin University from January 2012 to January 2013 were divided into two groups according to their serum hs-CRP values: Micro-inflammatory group (hs-CRP > 3mg/L) and normal group (hs-CRP < 3mg/L), including 100 patients in Micro-inflammatory group and 99 patients in normal group. General clinical data, blood pressure (BP), serum creatinine (Scr), hemoglobin (Hb), triglyceride (TG), cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), serum albumin (Alb) and left ventricular ejection fraction (EF), left ventricular end-diastolic diameter (LVDd), ventricular septal thickness (IVST) were compared and scored. SPSS19.0 software was used for data statistics. Normal or approximate normal distribution measurements were expressed as (x + s) and the mean of the two samples were compared by t-test of independent samples; skewed distribution measurements were expressed as median (lower quartile-upper quartile), and rank sum test was used for inter-group comparison; and counting data were used for comparison. _2 test. Linear correlation analysis (Pearson correlation analysis) was used to analyze the data correlation, P 0.05 had statistical significance.
Result:
1. General clinical data: Of 199 patients with CKD, 112 were males and 87 were females. Of the primary diseases, 97 were primary glomerular diseases (45.73%), 55 were diabetic nephropathy (27.64%), 37 were hypertensive nephropathy (18.59%), 8 were polycystic kidney disease (4.02%), 6 were chronic interstitial nephritis (3.02%), 1 was obstructive nephropathy (0.5%) and 1 was other (0.5%). There were 100 cases (50.25%) in the inflammatory state group and 99 cases (49.75%) in the normal group. The dialysis age of the patients in the Micro-inflammatory State group was longer than that of the normal group, and the difference was statistically significant (P < 0.05).
2. Biochemical indexes and cardiac structure and function indexes: Compared with the normal group, the levels of Scr and LVDd in the microinflammatory group increased, and the difference was statistically significant (P < 0.05). Hb, Hct, TP, Alb, TC, LDL-C, EF decreased, and the difference was statistically significant (P < 0.05). There was no significant difference in the levels of pr-Alb, TG, HDL-C and ApoA between the two groups (P > 0.05). The difference was not statistically significant (P > 0.05).
3. correlation: hs-CRP was positively correlated with Scr, BUN and LVSd (P < 0.05), and negatively correlated with Hb, Hct, TP, Alb and EF.
Conclusion:
1. Microinflammation accounted for 50.25% of CKD patients. With the decline of renal function, microinflammation can promote the deterioration of renal function.
2, micro inflammatory state may promote anemia, malnutrition, heart failure and other complications.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692

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