慢性肾脏病患者血清内脏脂肪素水平升高及其与颈动脉粥样硬化的关系

摘要

目的:观察慢性肾脏病(chronic kidney disease,CKD)患者血清内脏脂肪素(visfatin)水平,探讨其与颈动脉粥样硬化(atherosclerosis,AS)的关系.方法:入选CKD患者180例(非透析治疗102例,血液透析治疗78例)和年龄匹配的健康对照42例.ELISA检测血清visfatin,炎症指标IL-6和高敏C反应蛋白(high sensitive C-reactive proteins,hsCRP)水平;高分辨超声技术检测颈动脉内膜—中层厚度(intima media thickness,IMT),切面内膜中层(c IMT)面积及粥样硬化斑块.结果:CKD患者血清visfatin,IL-6,hsCRP水平均明显高于健康对照组(P＜0.01).透析CKD患者血清visfatin,IL-6,hsCRP水平均明显高于非透析CKD患者(P＜0.05).CKD患者血清visfatin水平与内生肌酐清除率(Ccr)呈负相关(r=-0.415,P＜0.05).颈动脉有斑块的CKD患者血清visfatin[(34.22±7.96)ng/mL)]明显高于无斑块者[(28.24±6.18) ng/mL,P＜0.05].直线相关分析显示CKD患者血清visfatin水平与IL-6(r=0.548,P＜0.001),hsCRP(r=0.430,P＜0.001),IMT(r=0.462,P＜0.05)及c IMT面积(r=0.411,P＜0.05)呈正相关.经Ccr、年龄、性别及其他与AS相关因素校正后,多因素逐步回归分析结果显示血清visftin是颈动脉IMT(β=0.433,P＜0.01)和c IMT面积(β=0.412,P＜0.01)的独立危险因素.结论:血清visfatin水平随肾功能减退而增高,可能成为CKD患者颈动脉粥样硬化的风险因子.%Objective:To determine the levels of visfatin in patients with chronic kidney disease (CKD) and to explore the relationship between visfatin levels and caroid atherosclerosis in CKD patients.Methods:A total of 180 CKD patients (102 non-dialyzed patients and 78 dialysis patients) and 42 healthy subjects enrolled in this study.The serum levels ofvisfatin,IL-6,and high sensitive C-reactive protein (hsCRP) were measured by ELISA.Common carotid arteries intima-media thickness (CCA-IMT),cross-sectional calculated intima-media thickness (c IMT) area and atherosclerotic plaque were detected by non-invasive high-resolution B-mode ultrasonography.Results:The serum levels of visfatin,IL-6 and hsCRP were significantly increased in CKD patients compared with age matched healthy subjects (P＜0.01).The serum levels of visfatin,IL-6 and hsCRP in the dialyzed patients were significantly higher than those in non-dialyzed patients (P＜0.05).Visfatin levels increased with the progression of renal dysfunction and inversely related to creatinine clearance (Ccr) in non-dialyzed patients (r=-0.415,P＜0.05).Patients with carotid artery plaques showed significantly higher levels of visfatin[(34.22±7.96) ng/mL)] compared with those without plaques [(28.24±6.18) ng/mL,P＜0.05].The serum levels of visfatin were closely correlated with IL-6 (r=-0.548,P＜0.001),hsCRP (r=0.430,P＜0.001),CCA-IMT (r=0.462,P＜0.05),and c IMT area (r=0.411,P＜0.05).After adjusting for GFR,age,gender,and other risk factors associated with atherosclerosis,multiple stepwise regression analysis showed that serum visfatin is a independent risk factor for CCA-IMT (β=0.433,P＜0.01) and c IMT area (β=0.412,P＜0.01).Conclusion:The serum level of visfatin increase with the progression of CKD and should be considered to be a new risk factor for atherosclerosis in CKD.