血清超敏C反应蛋白水平与慢性肾脏病患者心血管并发症发生风险关系的探讨

目的:探讨血清超敏C反应蛋白(hs-CRP)水平与慢性肾脏病(CKD)患者心血管并发症发生风险关系。方法:选择82例CKD患者与21例健康体检者为研究对象,根据肾小球滤过率(e GFR)将CKD患者分成CKDl~2期组、CKD3~4期组和CKD5期组。检测和比较各组hs-CRP、B型钠尿肽前体(pro-BNP)、尿素氮(BUN)、尿酸(UA)、肌酐(Cr)、前白蛋白(PA)、白蛋白(Alb)、同型半胱氨酸(Hcy)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、钙(Ca)、磷(P)、血红蛋白(Hb)的水平,同时评估患者是否有心肌缺血及心室肥厚、心脏瓣膜钙化表现。结果:随着e GFR下降,CKD患者血清hs-CRP水平呈上升趋势,不同CKD分期患者血清hs-CRP水平之间差异具有统计学意义(P0.01),CKD患者血清hs-CRP水平与BUN、Cr、UA、P、TG、Hcy、pro-BNP水平之间均存在明显的正相关(P0.05);血清hs-CRP水平与白蛋白、Hb、Ca、HDL之间均存在明显的负相关(P0.05);血清hs-CRP水平与前白蛋白、胆固醇、LDL之间无显著相关性(P0.05)。以hs-CRP为因变量,其他相关指标为自变量进行多元逐步回归分析,结果显示尿酸、Hb、Hcy进入多元逐步回归方程。以心肌缺血是否阳性和瓣膜钙化是否阳性为因变量,hs-CRP为自变量做logistic回归分析,结果显示血清hs-CRP水平为心肌缺血和瓣膜钙化的危险因素(OR1)。结论:CKD患者血清hs-CRP水平升高与其肾功能降低密切相关,且为其发生心肌缺血、心脏瓣膜钙化的危险因素。

A Study on the Relationship between Serum hs-CRP Level and the Risk of Cardiovascular Complications in Patients with Chronic Renal Disease

ABSTRACT Objective: To explore the relationship between serum high sensitivity C reactive protein(hs-CRP) and risk of cardio- vascular complications in patients with chronic kidney disease(CKD). Methods: 82 patients with CKD and 21 healthy subjects were se- lected as the subjects. According to the glomerular filtration rate, the patients with CKD were divided into group CKDl to 2, group CKD3 to group 4, group CKD5, and the healthy control group. The serum C reactive protein, pro-BNP, urea nitrogen, uric acid, creatinine, pre- albumn, albumin, homocysteine, triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, calcium, phosphorus, and hemoglobin levels were detected and compared between different groups. Patients with myocardial ischemia and ventricular hypertrophy and cardiac valve calcification were also evaluated. Results: With the decrease of eGFR, the level of hs-CRP showed an upward trend, and there were significant differences in the serum hs-CRP levels between different groups(P<0.01). There were significantly positive correlation between hs-CRP and blood urea nitrogen, creatinine, phosphorus, uric acid, triglyceride, homocysteine, pro-BNP (P<0.05); there were significantly negative correlation between hs-CRP and serum albumin, hemoglobin, calcium, high density lipoprotein (P<0.05); the correlation between hs-CRP and prealbumin, cholesterol low density lipoprotein showed no statistical significance(P>0.05). Hs-CRP was used as dependent variable, and other related indicators were used as independent variables for multiple stepwise regression analysis, the results showed that uric acid, Hb and Hcy entered multiple stepwise regression equation. Myocardial ischemia and valvular calcification were used as dependent variables. Hs-CRP was used as independent variable to do logistic regression analysis, the results showed that serum hs-CRP level was a risk factor for myocardial ischemia and valve calcification (OR>1). Conclusion: The increase of serum hs-CRP level in CKD patients is closely related to the decrease of renal function, and it is a risk factor for myocardial ischemia and cardiac valve calcification.