慢性肾衰竭高尿酸血症患者炎症因子、内皮功能与心脏功能改变的相关性

摘要

Objective To investigate the pathogenesis of hyperuricemia in chronic kidney disease (CKD) by observing plasma uric acid, high sensitivity C-reactive protein (hs-CRP), von wille-brand factor (vWF), and alteration of cardiac structure and function in CKD patients. Methods68 CKD patients and 20 health adults were included in the study. Patients were divided into 2 groups: group A with hyperuricemia and group B with normal uricemia. The concentrations of plasma uric acid, hs-CRP, and vWF as well as echocardiography were assessed in all groups. Results Concentrations of the examined biomarkers of both group A and group B were higher than those of the control group (P <0.05), and group A's were higher than group B's (P <0.05). There were significant changes in the left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), end-diastolic diameter (EDV), end systolic diameter (ESV), fractional shortening (FS), and ejection fraction (EF) in group A and B compared with the control group (P <0.05). Compared with group B, LAD, LVEDD, EDV, and ESV levels in group A increased significantly (P <0.05), while EF and FS decreased (P <0.05). Ventricular septal and left ventricular posterior wall remained unchanged. Conclusion In CKD patients with hyperuricemia, serum uric is directly correlated with hs-CRP, vWF, and injury of heart, which suggests that hyperuricemia may have harmful effects on CKD. Hyperuricemia may be a risky factor for cardiac structure and function alteration, especially for hypertrophy of left ventricular wall, the decrease of myocardial complialice and movement of ventricular wall.%目的 观察慢性肾脏疾病(CKD)患者的尿酸、超敏C-反应蛋白(hs-CRP)、血管性血友病因子(vWF)、心脏结构与功能改变情况,探讨高尿酸在慢性肾衰竭发病中的机制.方法 将68例CKD患者分为CKD合并高尿酸血症组(A组)及CKD组(B组),以20例健康体检者为对照组,清晨空腹抽血测定血尿酸、hs-CRP和vWF浓度,行心脏超声检查.结果 各组患者尿酸与hs-CRP、vWF水平变化,A组与B组均高于对照组(P＜0.05),A组高于B组(P＜0.05)；A组与B组的左心房内径、左心室舒张末期内径、左室舒张末期容量及收缩末期容量、短轴缩短率及射血分数与对照组相比差异均具有统计学意义(P＜0.05).A组与B组相比,A组的左心房内径、左心室舒张末期内径、左室舒张末期容量、收缩末期容量增加及射血分数、短轴缩短率降低显著多于B组(P＜0.05),但两组室间隔厚度、左心室后壁厚度的差异无统计学意义.结论 CKD合并高尿酸血症的患者,尿酸与hs-CRP、vWF水平、心脏损伤情况呈正相关,说明尿酸在慢性肾脏疾病中发挥了不良作用,高尿酸血症是心脏结构和功能异常,特别是左心室壁肥厚,心肌顺应性降低,心室壁运动减弱的危险因素.