CAJ | 학술논문

目的：探讨中介素（IMD）在慢性肾脏病（CKD）时的水平变化及其与同型半胱氨酸（Hcy）、胱抑素-C（Cyc-C）的相关性。方法检测30例正常人和147例CKD患者血浆IMD、肾上腺髓质素（ADM）和转化生长因子β1（TGF-β1）的浓度，患者根据肾小球滤过率分为1～5期，分析三者在不同分期的变化及其与Hcy、Cyc-C的相互关系。结果（1）随着CKD分期的不同，患者β2微球蛋白、Cyc-C、Hcy、GFR、ADM、TGF-β1水平与对照组相比，差异均有统计学意义（P＜0.05），IMD含量差异无统计学意义（P＞0.05）。（2）GFR＞60 ml/min的CKD患者中不同病因类型中IMD的含量：与对照组相比，血浆IMD含量在肾病综合征组、IgA肾病组水平明显升高，差异有统计学意义（P＜0.05）；各组ADM含量与对照组相比，差异无统计学意义。各组TGF-β1含量均明显高于对照组（P＜0.05）。（3）GFR＞60 ml/min的CKD患者中：IgA肾病组：IMD与Cys-C、Hcy均呈显著正相关（r＝0.900、0.900，P均＜0.05）。结论血浆IMD、ADM和TGF-β1在CKD进展中呈现一定变化趋势，尤其在IgA肾病早期变化明显，且与血管损伤因子Hcy、Cyc-C具有正相关性，提示IMD和ADM可能参与CKD血管损伤的病理过程；而TGF-β1在肾纤维化过程中的变化，反映了机体自我调节的作用。
목적：탐토중개소（IMD）재만성신장병（CKD）시적수평변화급기여동형반광안산（Hcy）、광억소-C（Cyc-C）적상관성。방법검측30례정상인화147례CKD환자혈장IMD、신상선수질소（ADM）화전화생장인자β1（TGF-β1）적농도，환자근거신소구려과솔분위1～5기，분석삼자재불동분기적변화급기여Hcy、Cyc-C적상호관계。결과（1）수착CKD분기적불동，환자β2미구단백、Cyc-C、Hcy、GFR、ADM、TGF-β1수평여대조조상비，차이균유통계학의의（P＜0.05），IMD함량차이무통계학의의（P＞0.05）。（2）GFR＞60 ml/min적CKD환자중불동병인류형중IMD적함량：여대조조상비，혈장IMD함량재신병종합정조、IgA신병조수평명현승고，차이유통계학의의（P＜0.05）；각조ADM함량여대조조상비，차이무통계학의의。각조TGF-β1함량균명현고우대조조（P＜0.05）。（3）GFR＞60 ml/min적CKD환자중：IgA신병조：IMD여Cys-C、Hcy균정현저정상관（r＝0.900、0.900，P균＜0.05）。결론혈장IMD、ADM화TGF-β1재CKD진전중정현일정변화추세，우기재IgA신병조기변화명현，차여혈관손상인자Hcy、Cyc-C구유정상관성，제시IMD화ADM가능삼여CKD혈관손상적병리과정；이TGF-β1재신섬유화과정중적변화，반영료궤체자아조절적작용。
Objective To investigate intermedin (IMD) in patients with chronic kidney disease (CKD) and its relationship with the levels of homocysteine (Hcy), cystatin-C (Cyc-C) correlation.Methods To detect 30 normal subjects and 147 patients with chronic kidney disease plasma IMD, ADM and TGF-β1 concentrations. Divided according to glomerular filtration rate in patients with stage 1-5, analyzed of changes of the three in different stages and its relationship with homocysteine, cystatin-C.Results Among the different stages of CKD, compared with control group, the β2 microglobulin, Cyc-C, Hcy, GFR, ADM, TGF-β1 levels were statistically significant (P<0.05), however, there was no significance in IMD (P>0.05). Among CKD patients (GFR>60 ml/min) with different types of pathogeny, compared with the control group, the IMD of plasma levels was significantly increased in nephrotic syndrome group and IgA nephropathy group, the difference was statistically significant (P<0.05); but ADM showed no difference in each group. While TGF-β1 levels in each group were significantly higher (P<0.05), and the IMD and Cys-C, Hcy showed a significant positive correlation in the IgA nephropathy group (r=0.900, 0.900, allP<0.05).Conclusion The IMD, ADM and TGF-β1 show certain trends in the progression of chronic kidney disease, especially in the early stage of IgA nephropathy, as well as vascular injury factors homocysteine and cystatin-C.The research suggest that IMD and ADM may involved in the pathological process of vascular injury in CKD; while TGF-β1 reflect the role of self-regulation in renal fibrosis.