摘要
目的 研究慢性肾脏病（CKD）患者血清游离脂肪酸（FFA）水平的变化及其与细胞因子及颈动脉病变的关系.方法 对188例CKD患者[非透析治疗130例,血液透析（HD）58例]的临床及实验室资料作回顾性研究,采用酶比色法检测FFA,应用颈动脉超声检查颈动脉病变的程度,同时检测高敏C反应蛋白（hsCRP）、血清IL-1β、IL-6和TNFα水平,分析FFA水平与此细胞因子及颈动脉病变的关系.结果 CKD患者无论透析与否,FFA水平较健康对照组显著升高[（492.63±143.59）比（302.65±142.18）μmol/L,P＜0.01],在非透析CKD患者中,随着肾功能的逐渐减退,血FFA水平也逐渐升高,各组间比较差异有统计学意义（P＜0.05或P＜0.01）,且HD组FFA水平较非透析CKD 5期更高（P＜0.05）.CKD患者hsCRP、IL-1β、IL-6、TNFα水平均显著高于健康对照组（P＜0.05或P＜0.01）,颈动脉内膜中层厚度（IMT）及斑块形成、颈动脉硬化的患病率较健康对照组显著升高（P＜0.05或P＜0.01）,HD组上述指标较非透析CKD5期均更高（P＜0.05）.直线相关分析显示,血FFA水平与hsCRP、IL-1β、IL-6、TNFα、TG及IMT、斑块形成、颈动脉硬化的患病率呈正相关（P＜0.05或P＜0.01）,与GFR呈负相关（P＜0.05）.多因素逐步回归分析显示,FFA、hsCRP和年龄是CKD患者颈动脉病变的独立危险因素.结论 非透析CKD及HD患者血清FFA水平均显著升高,且与hsCRP等微炎性反应的指标及颈动脉病变相关,提示高游离脂肪酸血症是CKD患者并发动脉粥样硬化的危险因素之一.
Objective To investigate the serum level of free fatty acid （FFA） and explore its relationship with cytokines and atherosclerosis （AS） in chronic kidney disease （CKD）.Methods The serum level of FFA was determined with enzymatic colorimetry.IL-1 β, IL-6 and TNFα were determined with ELISA.High-sensitivity C-reactive protein （hsCRP） was measured with immunoturbidimetry.Prevalence of atherosclerosis was detected with carotid ultrasonography.We evaluated the relationship between serum levels of FFA and IL-1β,IL-6, TNFα, hsCRP as well as the renal function in 130 adult patients with CKD, stratified according to the GFR （ based on the National Kidney Foundation/Kidney Dialysis Outcomes Quality Initiatives） and in 58 hemodialytic （HD） patients.The relationship between FFA level and cardiac geometry incidence in CKD patients was analyzed with logistic regression model.Results The serum level of FFA was significantly higher in CKD patients as compared with that in the healthy controls [（492.63 ± 143.59）vs （302.65 ± 142.18） μ mol/L, P 〈 0.01], even in the early stage of CKD.The level of FFA increased with the progression of renal dysfunction.In the non-dialytic CKD group, the level of FFA was negatively related to GFR and positively related to the proteinuria （P 〈 0.05）, while in the HD group, it was positively correlated with dialysis duration （ P 〈 0.05 ）.The serum levels of FFA were higher in CKD patients with carotid artery atherosclerosis than those in patients without （ P 〈 0.05 or 〈 0.01 ）.However, in both groups with impairment of renal function, the levels of FFA were positively correlated with hsCRP, IL-1 β, IL-6,TNFα and TG（ all P 〈 0.05 ）.A positive correlation between the level of FFA and the clinical manifestations such as carotid intimal medial thickness （IMT） and AS was also found.A negative correlation was found between the level of FFA and the serum level of albumin and GFR（ P 〈 0.05）.Conclusion Serum levels of FFA are significantly higher either in non-dialytic CKD or in HD patients and it is related with hsCRP, IL-1 β, IL-6, TNFα as well as carotid artery atherosclerosis, indicating that FFA is an independent risk factor of AS in CKD.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2010年第7期572-576,共5页
Chinese Journal of Internal Medicine
基金
上海市卫生局科技发展基金项目（2009255,2007Y71）
上海市闸北区卫生局科研基金（2009ZBMXK02）
上海市闸北区中心医院（长征医院闸北分院）“789攀登计划”
