本文選題：巨噬細(xì)胞移動(dòng)抑制因子 + 超敏C反應(yīng)蛋白　； 參考：《山東大學(xué)》2016年博士論文

【摘要】：研究背景：近10年來(lái),全球范圍內(nèi),慢性腎臟病(CKD)的患病率呈持續(xù)增長(zhǎng)的趨勢(shì)。在2007-2010年,在美國(guó)地區(qū)成年人CKD的患病率已經(jīng)上升到14%。在我國(guó),2012年張露霞等研究發(fā)現(xiàn)CKD在我國(guó)成年人中的患病率10.8%,對(duì)上海浦東新區(qū)、廣西省的城市和鄉(xiāng)鎮(zhèn)地區(qū)的調(diào)查顯示CKD在成年人群中患病率分別達(dá)到11%和14.4%,CKD已經(jīng)成為我們國(guó)家常見(jiàn)的疾病之一。但CKD患者如果未能得到及時(shí)有效治療,最終轉(zhuǎn)為終末期腎臟病,需要接受透析或移植治療,不僅患者的生活質(zhì)量會(huì)顯著下降,患者的社會(huì)勞動(dòng)能力也受到很大影響,而且治療CKD需要高額的醫(yī)療費(fèi)用,給個(gè)人和國(guó)家均帶來(lái)了沉重的經(jīng)濟(jì)壓力。CKD患者也增加了心血管疾病發(fā)生的危險(xiǎn)性,心血管疾病(CVD)是CKD患者的主要并發(fā)癥以及主要死亡原因之一。尤其是當(dāng)CKD持續(xù)進(jìn)展進(jìn)入到尿毒癥即終末期腎病(ESRD)階段,心血管疾病導(dǎo)致的死亡率占ESRD總病死率的45%-50%,其病死率高出一般人群的10-20倍[12]。在CKD心血管并發(fā)癥中,尿毒癥心肌病是終末期腎病(ESRD)特別是透析患者的首位死亡原因,其最顯著特征是左室肥厚(LVH)。LVH是ESRD和透析患者生存率降低的一個(gè)獨(dú)立危險(xiǎn)因素,其致病因素較為復(fù)雜。LVH在CKD早、中期開(kāi)始出現(xiàn),至慢性腎功能衰竭尿毒癥期透析病人LVH的發(fā)生率達(dá)74%,LVH導(dǎo)致了心室舒張功能紊亂、心律失常和心衰的出現(xiàn)。以往的研究發(fā)現(xiàn),尿毒癥LVH的發(fā)生主要與此類患者普遍存在的高血壓和高容量負(fù)荷有關(guān),但單純控制血壓和減輕容量負(fù)荷并不能顯著改善LVH。尿毒癥患者LVH出現(xiàn)的可能原因有除了體內(nèi)甲狀旁腺激素繼發(fā)性升高、鈣磷代謝異常和氧化應(yīng)激反應(yīng)外可能,微炎癥狀態(tài)是一個(gè)重要因素。研究表明,LVH與微炎癥狀態(tài)密切相關(guān),而巨噬細(xì)胞移動(dòng)抑制因子(MIF)是微炎癥狀態(tài)下升高的細(xì)胞因子的上游促炎因子,ESRD患者中MIF-173CC基因型表達(dá)上調(diào),與血清中微炎癥狀態(tài)的炎癥因子標(biāo)記物超敏C反應(yīng)蛋白(hs-CRP)的水平直接相關(guān)。在研究自身免疫性巨細(xì)胞性心肌炎時(shí)發(fā)現(xiàn),注射MIF中和抗體后,心肌炎癥病變顯著減輕。研究發(fā)現(xiàn),推測(cè)通過(guò)阻斷尿毒癥患者體內(nèi)MIF的作用可能會(huì)減輕尿毒癥心肌病的病變程度,可能是治療尿毒癥心肌病的新的研究方向,但目前尚無(wú)相關(guān)研究。研究目的：本研究旨在通過(guò)研究終末期腎病患者血清MIF與炎癥標(biāo)記物hs-CRP和心肌肥厚的相關(guān)性,探討炎癥因子MIF、hs-CRP對(duì)終末期腎臟病患者心室重塑的影響,探尋尿毒癥心肌病的動(dòng)態(tài)評(píng)價(jià)指標(biāo),對(duì)進(jìn)一步有效治療尿毒癥心肌病具有重要的理論與現(xiàn)實(shí)意義。研究方法：1.選擇2014年10月至2015年8月期間在山東省泰安市中心醫(yī)院、青島市中心醫(yī)院腎病內(nèi)科住院的144例終末期腎病患者為研究組。并且選取了30名性別和年齡都與終末期腎病患者符合的健康志愿者作為健康對(duì)照組。所有的被研究者均按納入標(biāo)準(zhǔn)入組并排除不符合入組要求的患者。根據(jù)ESRD患者是否進(jìn)行透析及透析情況將研究組分為終末期腎臟病未透析組(ND,n=63),血液透析組(HD,n=51)和腹膜透析組(PD,n=30),其中血液透析組患者均行低通量血液透析。2.檢測(cè)指標(biāo)：(1)收集患者的臨床資料和生化指標(biāo),包括年齡,性別,血壓等。同時(shí)分別在泰安市和青島市中心醫(yī)院檢驗(yàn)科,采用SYSMEX XE2100血液分析儀及配套試劑,分析檢測(cè)紅細(xì)胞、血紅蛋白等；(2)在泰安市和青島市中心醫(yī)院檢驗(yàn)科,嚴(yán)格按照ROCHE COBAS 8000全自動(dòng)電化學(xué)發(fā)光免疫分析儀及ROCHE配套試劑的常規(guī)操作步驟進(jìn)行操作,檢測(cè)總膽固醇(TC),甘油三酯(TG),高密度脂蛋白(HDL),低密度脂蛋白(LDL),極低密度脂蛋白(VLDL),載脂蛋白A (APOA),載脂蛋白B(APOB),脂蛋白(α)(LP(α)),前白蛋白(PA),白蛋白(ALB),鉀離子(K+),鈉離子(Na+),氯離子(Cl-),鈣離子(Ca2+),鎂離子(Mg2+),磷離子(p3+),尿素氮(BUN),肌酐(Cr),尿酸(UA),β2-微球蛋白(β2-MG),胱抑素C (CysC);使用免疫比濁法檢測(cè)不同組間的超敏C反應(yīng)蛋白(hs-CRP)水平,hs-CRP的正常值小于3mg/L；(3)在北醫(yī)三院實(shí)驗(yàn)室,采用液相芯片技術(shù)(美國(guó)Bio-plex懸浮蛋白芯片系統(tǒng))檢測(cè)ESRD患者及健康對(duì)照血清MIF水平,通過(guò)采用該公司的Bio-Plex human cytokinemulti-plex試劑盒,相應(yīng)的Bio-Plex cytokines試劑盒及對(duì)應(yīng)的檢測(cè)儀器,檢測(cè)不同組別之間的血漿MIF的水平,美國(guó)Bio-plex懸浮蛋白芯片技術(shù)可實(shí)現(xiàn)在一個(gè)反應(yīng)池中同時(shí)檢測(cè)同一標(biāo)本中的多種細(xì)胞因子進(jìn)行定性、定量的檢測(cè),通過(guò)在不同熒光編碼的微球上進(jìn)行抗原與抗體,配體與受體,酶與底物,核酸雜交反應(yīng),并使紅,綠兩束激光分別檢測(cè)微球編碼,報(bào)告熒光,從而實(shí)現(xiàn)定性和定量的目的。該液相芯片技術(shù)用于檢測(cè)細(xì)胞因子時(shí)大致可分為三步,首先將探針?lè)肿庸潭ㄓ谛酒砻?其次通過(guò)紅,綠兩束激光分別檢測(cè)微球編碼,再激發(fā)熒光的發(fā)生,實(shí)現(xiàn)熒光報(bào)告。數(shù)據(jù)分析系統(tǒng)應(yīng)用了Bio-Plex的管理軟件(version 4.0),使得檢測(cè)的敏感性在10pg/mL以下,能夠準(zhǔn)確檢測(cè)的細(xì)胞因子的濃度范圍達(dá)到1-32000pg/mL;(4)超聲心動(dòng)圖檢查：所有患者均采用IU22超聲系統(tǒng)(飛利浦醫(yī)療系統(tǒng),波塞爾,華盛頓州,美國(guó))測(cè)定左心室舒張末期內(nèi)徑(LVDD),室間隔厚度(IVST),左室射血分?jǐn)?shù)(LVEF%)和左室后壁厚度(LVPWT)。所有測(cè)量均由有經(jīng)驗(yàn)的超聲醫(yī)生進(jìn)行,重復(fù)三次取平均值。左室質(zhì)量(LVM)由公式計(jì)算出,LVM=0.8{1.04×[(LVDD+ IVST+LVPWT)3-LVDD3]}+06,除以體表面積為左室質(zhì)量指數(shù)(LVMI)。左室肥厚診斷條件：男性左室質(zhì)量指數(shù)134g/m2,女性左室質(zhì)量指數(shù)110g/m2。按上述標(biāo)準(zhǔn)將對(duì)象分為左室肥厚組和非肥厚組。尿毒癥心肌病的診斷標(biāo)準(zhǔn)按照既往的標(biāo)準(zhǔn)[35]。3.數(shù)據(jù)分析：統(tǒng)計(jì)分析采用SPSS21.0分析軟件。正態(tài)分布的變量用均數(shù)±標(biāo)準(zhǔn)差表示,非正態(tài)分布的變量用中位數(shù)和范圍表示。MIF、hs-CRP等非正態(tài)分布的變量組間比較采用Mann-Whitney檢驗(yàn)或Kruskal-Wallis檢驗(yàn)。Spearman秩相關(guān)檢驗(yàn)用于連續(xù)和有序變量。logistic回歸分析用于確定相對(duì)危險(xiǎn)度(RR)。P0.05為差異有統(tǒng)計(jì)學(xué)意義。研究結(jié)果：1.共納入符合標(biāo)準(zhǔn)的ESRD患者144例,其中男性80例(55.6%),女性64例(44.4%),年齡在19-86歲之間,平均年齡55.3±15.9歲。根據(jù)ESRD患者是否進(jìn)行透析及透析情況,將入選者分為三組：終末期腎臟病未透析組,血液透析組,腹膜透析組。三組之間在年齡和性別上沒(méi)有統(tǒng)計(jì)學(xué)差異。在這三組中,導(dǎo)致慢性腎臟病的原發(fā)病的主要以慢性腎小球腎炎和高血壓腎損害為主。2.ESRD患者血清MIF和hs-CRP水平：經(jīng)過(guò)Kruskal-Wallis檢驗(yàn),結(jié)果表明終末期腎病未透析組,腹膜透析組,血液透析組三組與對(duì)照組相比較,MIF水平具有統(tǒng)計(jì)學(xué)意義(p0.05),三組之間兩兩比較,結(jié)果顯示終末期腎病未透析組、血液透析組與和腹膜透析組血清MIF相比較,MIF水平均有統(tǒng)計(jì)學(xué)意義差異(p0.05)。經(jīng)過(guò)Kruskal-Wallis檢驗(yàn),我們發(fā)現(xiàn)hs-CRP的水平終末期腎病未透析組,腹膜透析組,血液透析組和健康對(duì)照組相比,差異具有統(tǒng)計(jì)學(xué)意義(p0.05),但是終末期腎病未透析組,血液透析組和腹膜透析組之間兩兩比較,hs-CRP差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。3.血清MIF水平與各項(xiàng)臨床指標(biāo)的相關(guān)分析結(jié)果：經(jīng)過(guò)spearman等級(jí)相關(guān)性分析,E SRD患者血清MIF水平與收縮壓,舒張壓,紅細(xì)胞計(jì)數(shù),總膽固醇,甘油三酯,載脂蛋白A,載脂蛋白B,肌酐,尿酸,β2微球蛋白,胱抑素C,鈉,氯,鈣,鎂,磷,左心室舒張末期內(nèi)徑,室間隔厚度,左室后壁厚度,左室射血分?jǐn)?shù)之間無(wú)相關(guān)性(P0.05)。但是血清MIF水平與超敏C反應(yīng)蛋白,血鉀和尿素氮呈正相關(guān)(p0.05),與血紅蛋白,白蛋白之間呈負(fù)相關(guān)(p0.05)。4.血清MIF水平與左心室肥厚的關(guān)系：根據(jù)超聲結(jié)果將ESRD患者分為左心室肥厚患者和非左心室肥厚患者,伴有左心室肥厚的ESR D患者血清MIF水平1186.0(170.0-3862.0) pg/mL,明顯高于非左室肥厚的ESRD患者228.5(55.0-2079.0)pg/mL (P0.05)。血清MIF水平與左心室質(zhì)量指數(shù)呈正相關(guān)。血清MIF大于1100pg/mL作為異常,低于或等于1100pg/mL為正常,logistic回歸分析用于驗(yàn)證血清MIF對(duì)左室肥厚的相對(duì)危險(xiǎn)度(RR)。結(jié)果表明,當(dāng)考慮優(yōu)勢(shì)比(OR)時(shí),高水平的血清MIF左室肥厚的發(fā)病率是低水平的血清MIF13.063倍,結(jié)果顯示MIF進(jìn)入回歸模型且有統(tǒng)計(jì)學(xué)意義(p0.05),提示血清MIF與ESRD患者的左室肥厚有相關(guān)性,血清MIF是ESRD患者左室肥厚的危險(xiǎn)因素。結(jié)論：1.終末期腎病(ESRD)患者的血清MIF和hs-CRP水平明顯升高,表明ESRD患者具有高M(jìn)IF血癥和微炎癥狀態(tài)。2.終末期腎病(ESRD)患者的血清MIF和hs-CRP可能共同參與了ESRD患者左心室肥厚的發(fā)生和發(fā)展。3.血清高M(jìn)IF水平是ESRD患者左心室肥厚病變的危險(xiǎn)因素。阻斷尿毒癥患者體內(nèi)MIF的作用可能會(huì)減輕尿毒癥心肌病的病變程度,從而為治療尿毒癥心肌病患者提供了臨床依據(jù)和理論基礎(chǔ)。
[Abstract]:Background: the prevalence of chronic kidney disease (CKD) has continued to increase over the past 10 years. In the 2007-2010 years, the prevalence of CKD in adults in the United States has risen to 14%. in China. In 2012, Zhang Luxia and other studies found that the prevalence rate of CKD in Chinese adults was 10.8%, to Pudong New Area, Shanghai, and Guangxi. The prevalence of CKD in the adult population is 11% and 14.4%, respectively, and CKD has become one of the common diseases in our country. But if CKD patients fail to get timely and effective treatment and eventually turn to end-stage renal disease, it is necessary to receive dialysis or transplant, not only the quality of life of the patients will be significantly reduced, but also the patient's quality of life will decrease significantly. Social labour capacity has also been greatly affected, and the treatment of CKD requires high medical costs and heavy economic pressure on both individuals and countries..CKD patients also increase the risk of cardiovascular disease, and cardiovascular disease (CVD) is one of the major complications of CKD patients and one of the main causes of death. Especially when CKD continues to progress. In the stage of uremia, end-stage renal disease (ESRD), the mortality of cardiovascular disease is 45%-50% of the total mortality of ESRD, and its mortality is 10-20 times higher than that of the general population [12]. in CKD cardiovascular complications. Uremic cardiomyopathy is the first cause of death in end-stage renal disease (ESRD), especially in dialysis patients. The most significant feature is the left ventricle. Hypertrophy (LVH).LVH is an independent risk factor for the decrease of survival rate in ESRD and dialysis patients. The pathogenicity of.LVH is more complex in the early stage of CKD and in the middle of the middle period. The incidence of LVH in patients with chronic renal failure uremia is 74%, and LVH leads to ventricular diastolic disorder, arrhythmia and heart failure. Previous studies found that The occurrence of uremia LVH is mainly associated with high blood pressure and high volume load prevalent in such patients. But the simple control of blood pressure and relieving capacity load can not significantly improve the possible causes of the occurrence of LVH in LVH. uremia patients, except for the secondary elevation of parathyroid hormone, abnormal calcium and phosphorus metabolism and oxidative stress reaction. Inflammatory state is an important factor. Studies have shown that LVH is closely related to microinflammatory state, and macrophage migration inhibitory factor (MIF) is the upstream proinflammatory factor of cytokines in the state of microinflammation. The expression of MIF-173CC genotype in ESRD patients is up-regulated and hypersensitive C reaction protein (H) with inflammatory factor markers in serum microinflammation state (H) S-CRP is a direct correlation. In the study of autoimmune giant cell myocarditis, it was found that after the injection of MIF neutralizing antibodies, the lesions of the myocarditis were significantly reduced. The study found that the role of MIF in uremic patients may reduce the degree of uremia cardiomyopathy, and may be a new research in the treatment of uremia cardiomyopathy. The purpose of this study is to investigate the relationship between serum MIF and inflammatory markers hs-CRP and myocardial hypertrophy in patients with end-stage renal disease, and to explore the effect of inflammatory factors MIF and hs-CRP on ventricular remodeling in patients with end-stage renal disease, and to explore the dynamic evaluation index of uremic cardiomyopathy. Effective treatment of uremic cardiomyopathy has important theoretical and practical significance. 1. the study group was selected from October 2014 to August 2015 in 144 patients with end-stage renal disease hospitalized in Tai'an Central Hospital of Shandong province and Qingdao Central Hospital of nephrology. And 30 sex and age were selected and the patients with end-stage nephrosis were selected. All the subjects were included in the healthy volunteers as a healthy control group. All the subjects were enrolled in the group according to the inclusion criteria and excluded the patients who did not meet the requirements of the group. According to the condition of ESRD patients undergoing dialysis and dialysis, the study group was divided into the end stage renal disease group (ND, n=63), the hemodialysis group (HD, n=51) and the peritoneal dialysis group (PD, n=30). The patients in the hemodialysis group received low flux hemodialysis.2. indicators: (1) collect the patients' clinical data and biochemical indexes, including age, sex, blood pressure, etc. at the same time in Tai'an and Qingdao City Center Hospital, using SYSMEX XE2100 blood analyzer and matching reagents, analysis and detection of red blood cells, hemoglobin and so on; (2) in Thai. An inspection department in an City and Qingdao Central Hospital, strictly according to the routine operation steps of the ROCHE COBAS 8000 full automatic electrochemiluminescence immunoanalyzer and the ROCHE kit, detected the total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), extremely low density lipoprotein (VLDL), and apolipoprotein A (APOA). Apolipoprotein B (APOB), lipoprotein (alpha) (alpha) (LP (alpha)), prealbumin (PA), albumin (ALB), potassium ion (K+), sodium ion (Cl-), calcium ion (Ca2+), magnesium ion (Mg2+), phosphorus ion (p3+), urea nitrogen (BUN), creatinine, uric acid (beta), beta microglobulin (beta), cystatin, and immunoturbidimetry At the level of hs-CRP, the normal value of hs-CRP is less than 3mg/L; (3) in the laboratory of No.3 Hospital of Beijing University, the serum MIF level of ESRD patients and healthy controls was detected by liquid chip technology (American Bio-plex suspension protein chip system) by using the company's Bio-Plex human cytokinemulti-plex kit and the corresponding Bio-Plex cytokines kit. And the corresponding detection instruments to detect the level of plasma MIF between different groups. The Bio-plex suspension protein chip technology in the United States can detect the multiple cytokine in the same specimen in a reaction pool for qualitative, quantitative detection, antigen and antibody, ligand and receptor, enzyme and enzyme on different fluorescent microspheres. The substrate, nucleic acid hybridization reaction, and the red and green two beam lasers are used to detect the microspheres encoding and report the fluorescence to achieve the purpose of qualitative and quantitative. The liquid chip technology can be roughly divided into three steps when used to detect cell factors. First, the probe molecules are fixed on the chip surface, and then the microspheres are encoded by red and green laser beams respectively. The data analysis system used the Bio-Plex management software (version 4), which made the sensitivity of the detection less than 10pg/mL, and the concentration range of the cytokine that could be accurately detected to reach 1-32000pg/mL; (4) the ultrasonic cardiogram examination: all patients adopted the IU22 ultrasound system (PHILPS medical system) The left ventricular end diastolic diameter (LVDD), interventricular septum thickness (IVST), left ventricular ejection fraction (LVEF%) and left ventricular posterior wall thickness (LVPWT) were measured. All measurements were performed by experienced ultrasound doctors and repeated three times. The left ventricular mass (LVM) was calculated by formula, LVM=0.8{1.04 * [(LVDD+ IVST+LVPWT) 3-LVDD3]}. +06, divided by the surface area of the left ventricular mass index (LVMI). Diagnostic criteria for left ventricular hypertrophy: the male left ventricular mass index 134g/m2. The female left ventricular mass index 110g/m2. was divided into the left ventricular hypertrophy group and the non hypertrophic group according to the above criteria. The diagnostic criteria for uremic cardiomyopathy were analyzed according to the previous standard [35].3. data: statistical analysis adopted SPS S21.0 analysis software. The variables of normal distribution are expressed by mean number and standard deviation, and the variables of non normal distribution are expressed in the median and range of.MIF, hs-CRP and other non normal distribution are compared by Mann-Whitney test or Kruskal-Wallis test.Spearman rank correlation test for.Logistic regression analysis of continuous and ordered variables for determination. The relative risk degree (RR).P0.05 was statistically significant. 1. a total of 144 cases of ESRD patients were included, including 80 men (55.6%), 64 women (44.4%), age 19-86, and the average age of 55.3 + 15.9. According to the condition of dialysis and dialysis for ESRD patients, the patients were divided into three groups: end-stage kidney There was no statistically significant difference in age and sex between the three groups. In these three groups, the main causes of chronic renal disease were chronic glomerulonephritis and hypertensive renal damage in the.2.ESRD patients' serum MIF and hs-CRP levels: Kruskal-Wallis test, the results showed the end of the end. The MIF level of the three groups in the non dialysis group, the peritoneal dialysis group and the hemodialysis group, compared with the control group, was statistically significant (P0.05), and 22 compared between the three groups. The results showed that the serum MIF phase of the hemodialysis group and the peritoneal dialysis group were significantly different (P0.05). After Kruskal-Wa, the level of MIF was statistically significant (P0.05). After Kruskal-Wa, the level of the hemodialysis group was significantly different. LLIS test, we found that the difference between the hs-CRP level end-stage renal disease group, the peritoneal dialysis group, the hemodialysis group and the healthy control group was statistically significant (P0.05), but the 22 ratio between the end stage renal disease group and the hemodialysis group and the peritoneal dialysis group was not statistically significant (P0.05).3. serum MIF level. Correlation analysis with various clinical indicators: after Spearman level correlation analysis, serum MIF level and systolic pressure, diastolic pressure, red blood cell count, total cholesterol, triglyceride, apolipoprotein A, apolipoprotein A, apolipoprotein B, creatinine, uric acid, beta 2 microglobulin, Cystatin C, sodium, chlorine, calcium, magnesium, phosphorus, left ventricular end diastolic diameter, ventricular septum, and interventricular septum were analyzed. There was no correlation between thickness, left ventricular posterior wall thickness and left ventricular ejection fraction (P0.05). But serum MIF level was positively correlated with hypersensitive C reactive protein, blood potassium and urea nitrogen (P0.05), and the relationship between serum MIF level and left ventricular hypertrophy was negatively correlated with hemoglobin and albumin (P0.05).4.: according to ultrasonic results, ESRD patients were divided into left ventricular fertilizer. Serum MIF level 1186 (170.0-3862.0) pg/mL in patients with thick and non left ventricular hypertrophy with left ventricular hypertrophy was 1186 (170.0-3862.0) pg/mL, significantly higher than 228.5 (55.0-2079.0) pg/mL (P0.05) in non left ventricular hypertrophy ESRD patients. Serum MIF level was positively correlated with the left ventricular mass index. Serum MIF was larger than 1100pg/mL as an anomaly, lower or equal to that of the ESRD. For normal, logistic regression analysis was used to verify the relative risk degree of serum MIF to left ventricular hypertrophy (RR). The results showed that the incidence of high level serum MIF left ventricular hypertrophy was MIF13.063 times at low level when considering the dominance ratio (OR). The results showed that MIF entered the regression model and had statistical significance (P0.05), suggesting that serum MIF and ESRD patients were in serum. The serum MIF is a risk factor for left ventricular hypertrophy in patients with ESRD. Conclusion: serum MIF and hs-CRP levels in patients with 1. end-stage renal disease (ESRD) are significantly higher, indicating that the serum MIF and hs-CRP in patients with ESRD and.2. end-stage renal disease (ESRD) in ESRD patients may participate in the left ventricle of the patients with ESRD. The occurrence and development of hypertrophy of.3. serum high MIF level is a risk factor for left ventricular hypertrophy in ESRD patients. Blocking the role of MIF in uremic patients may reduce the degree of uremic cardiomyopathy, thus providing a clinical basis and theoretical basis for the treatment of uremic cardiomyopathy.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R692.5;R54

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