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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-reactiveproteins,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 observe the serum visfatin level in patients with chronic kidney disease (CKD) and to explore its relationship with carotid atherosclerosis (AS). Methods: 180 CKD patients (102 without hemodialysis and 78 with hemodialysis) and 42 matched healthy controls were enrolled. Serum levels of visfatin, IL-6 and hsCRP were detected by ELISA. The carotid intima media thickness (IMT) (c IMT) area and atherosclerotic plaques. Results: The serum levels of visfatin, IL-6 and hsCRP in CKD patients were significantly higher than those in healthy controls (P <0.01). Serum levels of visfatin, IL-6 and hsCRP in dialysis CKD patients were significantly higher than those in non-dialysis CKD patients (P <0.05). Serum visfatin levels were negatively correlated with endogenous creatinine clearance (Ccr) in patients with CKD (r = -0.415, P <0.05). Serum visfatin [(34.22 ± 7.96) ng / mL) in CKD patients with carotid artery plaque was significantly higher than those without plaque (28.24 ± 6.18 ng / mL, P <0.05). The linear correlation analysis showed that the serum visfatin levels in patients with CKD were significantly lower than those in patients with IL-6 (r = 0.548, P <0.001), hsCRP (r = 0.430, = 0.411, P <0.05). After adjustment for Ccr, age, gender and other factors related to AS, stepwise regression analysis showed that serum visftin was significantly higher in carotid IMT (β = 0.433, P <0.01) and c IMT area Of independent risk factors. Conclusions: Serum visfatin levels increase with renal dysfunction and may be a risk factor for carotid atherosclerosis in CKD patients.