CAJ | 학술논문

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.
목적 연구만성신장병(CKD)환자혈청유리지방산(FFA)수평적변화급기여세포인자급경동맥병변적관계.방법 대188례CKD환자[비투석치료130례,혈액투석(HD)58례]적림상급실험실자료작회고성연구,채용매비색법검측FFA,응용경동맥초성검사경동맥병변적정도,동시검측고민C반응단백(hsCRP)、혈청IL-1β、IL-6화TNFα수평,분석FFA수평여차세포인자급경동맥병변적관계.결과 CKD환자무론투석여부,FFA수평교건강대조조현저승고[(492.63±143.59)비(302.65±142.18)μmol/L,P＜0.01],재비투석CKD환자중,수착신공능적축점감퇴,혈FFA수평야축점승고,각조간비교차이유통계학의의(P＜0.05혹P＜0.01),차HD조FFA수평교비투석CKD 5기경고(P＜0.05).CKD환자hsCRP、IL-1β、IL-6、TNFα수평균현저고우건강대조조(P＜0.05혹P＜0.01),경동맥내막중층후도(IMT)급반괴형성、경동맥경화적환병솔교건강대조조현저승고(P＜0.05혹P＜0.01),HD조상술지표교비투석CKD5기균경고(P＜0.05).직선상관분석현시,혈FFA수평여hsCRP、IL-1β、IL-6、TNFα、TG급IMT、반괴형성、경동맥경화적환병솔정정상관(P＜0.05혹P＜0.01),여GFR정부상관(P＜0.05).다인소축보회귀분석현시,FFA、hsCRP화년령시CKD환자경동맥병변적독립위험인소.결론 비투석CKD급HD환자혈청FFA수평균현저승고,차여hsCRP등미염성반응적지표급경동맥병변상관,제시고유리지방산혈증시CKD환자병발동맥죽양경화적위험인소지일.
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.