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目的 观察慢性肾脏病(CKD)患者循环中晚期氧化蛋白产物(AOPP)水平,并探讨其与动脉粥样硬化的关系。方法 断面队列研究。选109例CKD患者和71例健康对照者,用高分辨B超测颈动脉内膜中层厚度(IMT)、切面内膜中层面积及粥样斑块。测血清AOPP、丙二醛、谷胱苷肽过氧化物酶活性(GSHPx)和C 反应蛋白水平。结果 CKD患者血清AOPP水平明显高于健康对照者(P<0 01), 62例透析者血清AOPP水平明显高于47例未透析者(P<0 01);未透析者血清AOPP水平与内生肌酐清除率呈负相关(r=-0 292, P<0 05)。38例有颈动脉粥样斑块者血清AOPP水平明显高于71例无颈动脉粥样斑块者(P<0 01)。单因素相关分析和多因素逐步回归分析均显示,血清AOPP水平与颈动脉IMT、切面内膜中层面积呈正相关(r=0 332,r=0 288,P值均小于0 05;β=0 313,P<0 001;β=0 301,P<0 01)。CKD患者血清AOPP水平与丙二醛、C 反应蛋白呈正相关(r=0 300,P=0 01;r=0 255,P<0 05 ),与血清GSHPx呈负相关(r=-0 647,P<0 01 )。结论CKD患者普遍存在高AOPP血症,血清AOPP水平随肾功能减退而增高,并与CKD患者动脉粥样硬化密切相关。
Objective To investigate the level of circulating middle and late oxidized protein product (AOPP) in patients with chronic kidney disease (CKD) and to explore its relationship with atherosclerosis. Method Cross-section cohort study. One hundred and nine patients with CKD and 71 healthy controls were included in this study. The carotid intima - media thickness (IMT), medial intima area and atherosclerotic plaque were measured by high - resolution. Serum AOPP, malondialdehyde, glutathione peroxidase (GSHPx) and C-reactive protein levels were measured. Results The serum level of AOPP in CKD patients was significantly higher than that in healthy controls (P <0.01). The serum AOPP levels in 62 dialysis patients were significantly higher than those in 47 non-dialyzed patients (P <0.01) Creatinine clearance was negatively correlated (r = -0 292, P <0.05). Serum AOPP levels were significantly higher in 38 patients with carotid atherosclerotic plaque than in 71 carotid atherosclerotic plaques (P <0.01). Univariate correlation analysis and stepwise regression analysis showed that serum AOPP levels were positively correlated with carotid IMT and cutaneous intima-media area (r = 0 332, r = 0 288, P values were less than 0 05; β = 0 313 , P <001; β = 0 301, P <0 01). Serum AOPP level in CKD patients was positively correlated with MDA and CRP (r = 0 300, P = 0 01; r = 0 255, P 0 05), but negatively correlated with serum GSHPx (r = -0 647, P <0 01). Conclusions The prevalence of AOPP in CKD patients is high. Serum AOPP level increases with renal dysfunction and is closely related to atherosclerosis in CKD patients.