慢性肾脏病患者血栓调节蛋白与动脉粥样硬化的相关性

目的 探讨慢性肾脏病(CKD)患者血栓调节蛋白（Tm）水平与动脉粥样硬化（AS）的相关性。 方法 以北京朝阳医院肾内科住院的96例CKD患者为对象，其中血液透析32例，非透析64例；30例健康志愿者为对照。参试者均于清晨空腹采静脉血，分别测定Scr、胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、C反应蛋白、血红蛋白及血栓调节蛋白。应用彩色多普勒超声检测颈动脉内膜中层厚度（IMT）。对血栓调节蛋白与IMT及相关参数进行相关分析。 结果 CKD患者血栓调节蛋白为（12.15±3.04） mg/L，显著高于健康对照组的（3.12±0.23） mg/L（P < 0.01）。血液透析组血栓调节蛋白为（16.89±3.35） mg/L，显著高于非透析组的（9.78±2.49） mg/L（P < 0.01）。血液透析组IMT值为（1.13±0.31） mm，斑块检出率为48.5%，均显著高于非透析治疗组的（0.95±0.33） mm和28.7%（均P < 0.05）。96例CRF患者的Tm水平与IMT呈正相关（r = 0.335，P < 0．01）。动脉病变程度越重者，血浆Tm水平越高。多元逐步回归分析结果显示，Tm（OR=1.13，95%CI 1.010~1.121）、SBP（OR=1.09，95%CI 1.009~1.114）、CRP（OR=1.22，95%CI 1.216~2.007）分别与CKD患者IMT独立相关。 结论 CKD患者Tm水平与IMT独立相关。血管内皮细胞损伤与CKD患者动脉粥样硬化并发症密切相关。Tm有可能成为血管内皮细胞损伤或功能紊乱的标志物。

Correlation between thrombomodulin and atherosclerosis in chronic kidney diseases patients

Objective To determine the correlation between thrombomodulin and atherosclerosis in chronic kidney diseases (CKD) patients. Methods A total of 96 CKD patients in our hospital were enrolled in the study, including 32 maintenance hemodialysis (MHD) patients and 64 non-hemodialysis CKD patients with stage 2 to 5 (non-HD) and 30 age- and gendermatched healthy volunteers were used as control.Intima-media thickness (IMT) and atherosclerotic plaques of the extracranial common carotid artery were detected by high-resolution B-mode ultrasonography. Blood level of thrombomodulin was measured using ELISA, and creatinine,triglycerides, cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol were measured routinely as well.Correlation analysis of thrombomodulin with other parameters was performed. Results The thrombomodulin level was significantly higher in CKD patients as compared to healthy controls (12.15±3.04) mg/L vs (3.12±0.23) mg/L, P＜0.05], and also significantly higher in MHD patients as compared to non-HD patients (16.89±3.35) mg/L vs (9.78±2.49) mg/L, P＜0.05].The atherosclerotic plaques incidence and IMT value of carotid artery increased significantly in CKD patients compared with healthy volunteers.Thrombomodulin was positively correlated with IMT in CKD patients (r=0.335, P＜0.01).Multiple stepwise regression analysis showed that thrombomodulin, Tm (OR=1.13, 95％CI 1.010-1.121), SBP (OR=1.09, 95％GI 1.009-1.114), CRP (OR=1.22, 95％CI 1.216-2.007), and Scr were independent risk factors of IMT. Conclusion Thrombomodulin is correlated with carotid atherosclerosis in CKD patients and may be used as a marker to evaluate the endothelial damage.