透析患者微炎狀態(tài)和甲狀旁腺激素與頸動脈硬化的關(guān)系
發(fā)布時間：2019-06-18 18:48
【摘要】：目的臨床觀察發(fā)現(xiàn)維持性血液透析(MHD)患者心血管疾病的發(fā)生率和死亡率明顯增高,其中動脈粥樣硬化(AS)是心血管疾病發(fā)生發(fā)展的重要危險因素。而AS的傳統(tǒng)危險因素如年齡、高血壓、高血糖、高密度脂蛋白膽固醇降低及低密度脂蛋白膽固醇升高等,不足以預測MHD患者心血管疾病的危險性,提示還存在一些其他非傳統(tǒng)的危險因素。本課題研究主要探討MHD患者微炎狀態(tài)和血清甲狀旁腺激素水平(PTH)水平與頸動脈內(nèi)膜一中層厚度(IMT)的相關(guān)性,以及兩者在MHD患者動脈粥樣硬化發(fā)生中的作用,為進一步探討預防和治療MHD患者心血管高風險性的方法奠定基礎(chǔ)。方法在解放軍第八十八醫(yī)院院血液凈化中心隨機選取90例維持性血液透析(MHD)患者(其中男性54例,女性36例),透析時間10~120個月,另取同期年齡及性別比例與病例組相匹配的在本院查體正常的30例為對照組(男性18例,女性12例),病例組和對照組共120例。所有實驗對象均進行頸動脈血管彩色多普勒超聲檢查,記錄斑塊的有無,頸動脈內(nèi)中膜厚度,詳細詢問并記錄研究對象的臨床資料。詳細詢問研究對象的既往史,個人史及家族史。所有受試對象于透析前禁食8-10小時,于次日清晨空腹臥位抽取肘靜脈血約6-8ml,應(yīng)用全自動生化分析儀測定常規(guī)生化指標,其中包括血常規(guī)(Rt)、血清肌酐(Scr)、尿素氮(BUN)、血糖、總膽固醇(Ch)、甘油三酯(TG)、血清總蛋白(TP)和白蛋白(ALB)等。同時空腹狀態(tài)下檢測患者血清甲狀旁腺激素,C-反應(yīng)蛋白、IL-6、TNF-α。所有數(shù)據(jù)采用SPSS15.0統(tǒng)計軟件處理。結(jié)果1.維持性血液透析(MHD)患者血清C-反應(yīng)蛋白、IL-6、TNF-α水平健康對照組比較:MHD患者C反應(yīng)蛋白水平(8.943±9.9622ng/ml)明顯高于對照組(1.746±1.2483ng/ml)(P0.05);MHD患者IL-6水平(158.0888±2.8308pg/ml)明顯高于對照組(85.077±35.9416pg/ml)P0.05);MHD患者TNF-α水平(106.36±47.953ng/l)明顯高于對照組(106.36±47.953ng/l)(P0.05)。2.維持性血液透析(MHD)患者甲狀旁腺激素水平與對照組比較:MHD患者甲狀旁腺激素水平(183.532±252.1534pg/ml)明顯高于對照組(29.520±15.5312pg/ml)(P0.05)。3.維持性血液透析(MHD)患者頸動脈IMT水平與對照組比較:MHD患者頸動脈IMT水平(1.308±0.7053mm)明顯高于對照組(0.451±0.3999mm)(P0.05)。4.維持性血液透析(MHD)患者頸動脈超聲異常組(包括內(nèi)膜增厚及斑塊形成)與頸動脈超聲正常組血清C-反應(yīng)蛋白、IL-6、TNF-α水平和甲狀旁腺激素水平比較:動脈超聲異常組C-反應(yīng)蛋白、IL-6、TNF-α水平和甲狀旁腺激素明顯高于頸動脈超聲正常組(P0.05)。5.維持性血液透析(MHD)患者高CRP組PTH水平及頸動脈IMT水平與CRP正常組比較:高CRP組PTH水平及頸動脈IMT水平明顯高于CRP正常組(P0.05)。6.維持性血液透析(MHD)患者高PTH組CRP水平及頸動脈IMT水平與PTH正常組比較:高PTH組CRP水平及頸動脈IMT水平明顯高于PTH正常組(P0.05)。7.多元線性回歸分析顯示:維持性血液透析(MHD)患者頸動脈IMT與血清PTH(β=0.177 P0.05)、C-反應(yīng)蛋白(β=0.244 P0.05)、血紅蛋白、白蛋白等密切相關(guān)。提示血PTH與C-反應(yīng)蛋白直接參與了動脈粥樣硬化、粥樣斑塊的形成。8.Logistic逐步回歸分析顯示:血清PTH水平(β=1.999 95%CI:2.732-19.954 P0.01)是MHD患者動脈粥樣硬化的獨立危險因素之一。結(jié)論1.MHD患者普遍存在微炎癥狀態(tài)和高PTH血癥。2.高PTH血癥與微炎癥狀態(tài)和MHD患者高發(fā)動脈粥樣硬化性心血管事件相關(guān)。3.血清PTH可能和微炎癥反應(yīng)相互作用而且共同參與了MHD患者動脈粥樣硬化的形成。
[Abstract]:Objective To observe the incidence and mortality of cardiovascular diseases in patients with maintenance hemodialysis (MHD), and atherosclerosis (AS) is an important risk factor for the development of cardiovascular disease. The traditional risk factors of AS, such as age, hypertension, hyperglycemia, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, are not enough to predict the risk of cardiovascular disease in patients with MHD, and there are some other non-traditional risk factors. The relationship between the level of microinflammation and the level of serum parathyroid hormone (PTH) and the intima-media thickness (IMT) in the patients with MHD and the role of both in the occurrence of atherosclerosis in patients with MHD were studied. To further explore the method of preventing and treating high risk of cardiovascular high risk in patients with MHD. Methods 90 patients with maintenance hemodialysis (MHD) (54 male and 36 female) were randomly selected in the blood purification center of the Eighth Hospital of the People's Liberation Army (PLA), and the dialysis time was 10-120 months. A total of 120 cases of the control group (18 males and 12 females) and 120 cases of the control group were matched with the case group in the same age and sex ratio. All the subjects were examined by carotid artery color Doppler ultrasound, the presence or absence of the plaque, the thickness of the media in the carotid artery, and the clinical data of the subject. The study object's previous history, personal history, and family history were asked in detail. All subjects were fasted for 8-10 hours prior to dialysis, and the elbow venous blood was extracted in an empty position on the morning of the next morning for about 6-8 ml, and the routine biochemical indexes were measured by a full-automatic biochemical analyzer, including blood routine (Rt), serum myoglobin (Scr), urea nitrogen (BUN), blood sugar and total cholesterol (Ch). Triglyceride (TG), total serum protein (TP) and albumin (ALB), etc. In the same time, the serum parathyroid hormone, C-reactive protein, IL-6 and TNF-1 were detected in the fasting state. All data is processed using the SPSS10.0 statistical software. Results 1. The serum C-reactive protein, IL-6 and TNF-1 levels in the patients with maintenance hemodialysis (MHD) were compared with those in the control group: the level of C-reactive protein in MHD patients (8.943-9.9622 ng/ ml) was significantly higher than that in the control group (1.746-1.2483 ng/ ml) (P0.05); The level of IL-6 in MHD patients (158.0888-2.8308 pg/ ml) was significantly higher than that in the control group (85.077 and 35.9416 pg/ ml) (P0.05); the level of TNF-6 in MHD patients (106.36, 47.953 ng/ l) was significantly higher than that in the control group (106.36, 47.953 ng/ l) (P0.05). The level of parathyroid hormone in patients with maintenance hemodialysis (MHD) was compared with that of the control group: the level of parathyroid hormone (183.532, 252.1534 pg/ ml) in MHD patients was significantly higher than that in the control group (29.520-15.5312 pg/ ml) (P0.05). The IMT of the carotid artery in the patients with maintenance hemodialysis (MHD) was compared with that of the control group: the IMT of the carotid artery in MHD patients (1.308, 0.7053 mm) was significantly higher than that in the control group (0.451, 0.3999 mm) (P0.05). The serum C-reactive protein, IL-6, TNF-1 level and parathyroid hormone level in the carotid ultrasound abnormal group (including intimal thickening and plaque formation) in the patients with maintenance hemodialysis (MHD) were compared with the serum C-reactive protein, IL-6, TNF-1 level and parathyroid hormone level in the normal group of carotid ultrasound: C-reactive protein, IL-6, The level of TNF-1 and the parathyroid hormone were significantly higher than that of the normal carotid artery (P0.05). The levels of PTH and IMT of the high CRP group in the patients with maintenance hemodialysis (MHD) were higher than those in the normal group (P <0.05). The level of CRP and IMT of the high PTH group in the patients with maintenance hemodialysis (MHD) were higher than that in the normal group of PTH (P0.05). The multivariate linear regression analysis showed that the IMT of the carotid artery IMT in the maintenance hemodialysis (MHD) was closely related to the serum PTH (P = 0.177 P0.05), the C-reactive protein (P = 0.244 P.05), the hemoglobin, the albumin, and so on. The results showed that PTH and C-reactive protein were directly involved in the formation of atherosclerosis and the formation of atheromatous plaque. Logistic regression analysis showed that the serum PTH level (P = 1.999 95% CI: 2.732-19.954P0.01) was one of the independent risk factors of atherosclerosis in patients with MHD. Conclusion 1. There is a prevalence of microinflammation and high PTH in MHD patients. High PTH is associated with a high incidence of atherosclerotic cardiovascular events in patients with microinflammation and MHD. Serum PTH may interact with the microinflammatory reaction and co-operate with the formation of atherosclerosis in patients with MHD.
【學位授予單位】：泰山醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692.5;R54
本文編號：2501703
[Abstract]:Objective To observe the incidence and mortality of cardiovascular diseases in patients with maintenance hemodialysis (MHD), and atherosclerosis (AS) is an important risk factor for the development of cardiovascular disease. The traditional risk factors of AS, such as age, hypertension, hyperglycemia, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, are not enough to predict the risk of cardiovascular disease in patients with MHD, and there are some other non-traditional risk factors. The relationship between the level of microinflammation and the level of serum parathyroid hormone (PTH) and the intima-media thickness (IMT) in the patients with MHD and the role of both in the occurrence of atherosclerosis in patients with MHD were studied. To further explore the method of preventing and treating high risk of cardiovascular high risk in patients with MHD. Methods 90 patients with maintenance hemodialysis (MHD) (54 male and 36 female) were randomly selected in the blood purification center of the Eighth Hospital of the People's Liberation Army (PLA), and the dialysis time was 10-120 months. A total of 120 cases of the control group (18 males and 12 females) and 120 cases of the control group were matched with the case group in the same age and sex ratio. All the subjects were examined by carotid artery color Doppler ultrasound, the presence or absence of the plaque, the thickness of the media in the carotid artery, and the clinical data of the subject. The study object's previous history, personal history, and family history were asked in detail. All subjects were fasted for 8-10 hours prior to dialysis, and the elbow venous blood was extracted in an empty position on the morning of the next morning for about 6-8 ml, and the routine biochemical indexes were measured by a full-automatic biochemical analyzer, including blood routine (Rt), serum myoglobin (Scr), urea nitrogen (BUN), blood sugar and total cholesterol (Ch). Triglyceride (TG), total serum protein (TP) and albumin (ALB), etc. In the same time, the serum parathyroid hormone, C-reactive protein, IL-6 and TNF-1 were detected in the fasting state. All data is processed using the SPSS10.0 statistical software. Results 1. The serum C-reactive protein, IL-6 and TNF-1 levels in the patients with maintenance hemodialysis (MHD) were compared with those in the control group: the level of C-reactive protein in MHD patients (8.943-9.9622 ng/ ml) was significantly higher than that in the control group (1.746-1.2483 ng/ ml) (P0.05); The level of IL-6 in MHD patients (158.0888-2.8308 pg/ ml) was significantly higher than that in the control group (85.077 and 35.9416 pg/ ml) (P0.05); the level of TNF-6 in MHD patients (106.36, 47.953 ng/ l) was significantly higher than that in the control group (106.36, 47.953 ng/ l) (P0.05). The level of parathyroid hormone in patients with maintenance hemodialysis (MHD) was compared with that of the control group: the level of parathyroid hormone (183.532, 252.1534 pg/ ml) in MHD patients was significantly higher than that in the control group (29.520-15.5312 pg/ ml) (P0.05). The IMT of the carotid artery in the patients with maintenance hemodialysis (MHD) was compared with that of the control group: the IMT of the carotid artery in MHD patients (1.308, 0.7053 mm) was significantly higher than that in the control group (0.451, 0.3999 mm) (P0.05). The serum C-reactive protein, IL-6, TNF-1 level and parathyroid hormone level in the carotid ultrasound abnormal group (including intimal thickening and plaque formation) in the patients with maintenance hemodialysis (MHD) were compared with the serum C-reactive protein, IL-6, TNF-1 level and parathyroid hormone level in the normal group of carotid ultrasound: C-reactive protein, IL-6, The level of TNF-1 and the parathyroid hormone were significantly higher than that of the normal carotid artery (P0.05). The levels of PTH and IMT of the high CRP group in the patients with maintenance hemodialysis (MHD) were higher than those in the normal group (P <0.05). The level of CRP and IMT of the high PTH group in the patients with maintenance hemodialysis (MHD) were higher than that in the normal group of PTH (P0.05). The multivariate linear regression analysis showed that the IMT of the carotid artery IMT in the maintenance hemodialysis (MHD) was closely related to the serum PTH (P = 0.177 P0.05), the C-reactive protein (P = 0.244 P.05), the hemoglobin, the albumin, and so on. The results showed that PTH and C-reactive protein were directly involved in the formation of atherosclerosis and the formation of atheromatous plaque. Logistic regression analysis showed that the serum PTH level (P = 1.999 95% CI: 2.732-19.954P0.01) was one of the independent risk factors of atherosclerosis in patients with MHD. Conclusion 1. There is a prevalence of microinflammation and high PTH in MHD patients. High PTH is associated with a high incidence of atherosclerotic cardiovascular events in patients with microinflammation and MHD. Serum PTH may interact with the microinflammatory reaction and co-operate with the formation of atherosclerosis in patients with MHD.
【學位授予單位】：泰山醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692.5;R54
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相關(guān)期刊論文 前2條
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2 王劍青,鄧安國,戴勇;維持性血液透析患者微炎癥狀態(tài)相關(guān)因子的變化[J];臨床內(nèi)科雜志;2005年07期
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