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目的探讨维持性血液透析(MHD)患者血清脂联素(ADPN)质量浓度与慢性炎症、动脉粥样硬化的关系。方法选择2005年10月至2006年1月首都医科大学附属北京朝阳医院肾内科MHD患者60例和对照者30例,分别测定血清ADPN和C-反应蛋白(CRP)、白细胞介素-6(IL-6),应用彩色多普勒超声检测颈动脉内膜-中层厚度(IMT)及肱动脉舒张功能的变化。结果MHD患者血清ADPN(0.99±0.37)明显高于对照组(0.39±0.14)。血清ADPN与CRP、IL-6呈负相关(r分别为-0.22、-0.31、P<0.05)。MHD患者IMT非增厚者血清ADPN(1.24±0.31)明显高于增厚者血清ADPN(0.74±0.29)。血清ADPN与颈动脉IMT呈负相关(r为-0.26,P<0.05)。MHD患者反应性充血后肱动脉内径变化率明显低于对照组,血清ADPN与反应性充血后肱动脉内径变化率呈正相关(r为0.27,P<0.05),多元逐步回归分析表明血清ADPN是颈动脉IMT及反应性充血后肱动脉内径变化率的影响因素。结论维持性血液透析患者血清ADPN升高,高质量浓度的ADPN可以减少维持性血液透析患者慢性炎症、动脉粥样硬化的发生。
Objective To investigate the relationship between serum adiponectin (ADPN) concentration and chronic inflammation and atherosclerosis in maintenance hemodialysis (MHD) patients. Methods Sixty patients with MHD in the Department of Nephrology of Beijing Chaoyang Hospital affiliated to Capital Medical University from January 2005 to January 2006 were enrolled in the study. Serum levels of ADPN, C-reactive protein (CRP), interleukin-6 (IL) -6). The changes of carotid intima - media thickness (IMT) and brachial artery diastolic function were detected by color Doppler sonography. Results Serum ADPN (0.99 ± 0.37) in MHD patients was significantly higher than that in control group (0.39 ± 0.14). Serum ADPN was negatively correlated with CRP and IL-6 (r = -0.22, -0.31, P <0.05, respectively). Serum ADPN (1.24 ± 0.31) was significantly higher in IMD non-thickened MHD patients than that in thickening patients (0.74 ± 0.29). Serum ADPN was negatively correlated with carotid IMT (r = -0.26, P <0.05). The rate of change of brachial artery diameter after reactive hyperemia in MHD patients was significantly lower than that in control group. The ADPN of serum was positively correlated with the change rate of brachial artery diameter after reactive hyperemia (r = 0.27, P <0.05). Multivariate stepwise regression analysis showed that serum ADPN was Factors affecting the rate of change of brachial artery diameter after arterial IMT and reactive hyperemia. Conclusions Serum ADPN is elevated in patients with maintenance hemodialysis and high-concentration ADPN can reduce chronic inflammation and atherosclerosis in maintenance hemodialysis patients.