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外周血单个核细胞NF-κB水平与维持性血液透析患者心血管疾病及预后的关系
作者:张羽1  廖畅1  吕鑫1  王晓旭2  焦军东3 
单位:1. 哈尔滨医科大学附属第二医院 肾内三科, 黑龙江 哈尔滨 150000;
2. 哈尔滨市第一医院 感染免疫科, 黑龙江 哈尔滨 150000;
3. 哈尔滨医科大学附属第二医院 肾内科, 黑龙江 哈尔滨 150000
关键词:维持性血液透析 心血管疾病 NF-κB 死亡率 
分类号:R459.5
出版年·卷·期(页码):2019·47·第八期(951-955)
摘要:

目的:探讨维持性血液透析患者(MHD)外周血单个核细胞NF-κB水平与心血管疾病(CVD)及全因死亡、心血管疾病(CVD)死亡的关系,评估NF-κB对MHD患者预后的影响。方法:选取2012年1月在我院接收MHD治疗且大于6个月的终末期肾衰竭患者(160例)作为研究对象,采用ELISA法检测NF-κB水平。所有患者随访5年,记录新发的非致死性CVD和患者的死亡原因和时间。根据NF-κB四分位数,将患者分为四组,A组(NF-κB<750.82 ng·mg-1核蛋白)、B组(750.82 ng·mg-1核蛋白≤ NF-κB<1 142.42 ng·mg-1核蛋白)、C组(1 142.42 ng·mg-1核蛋白≤ NF-κB<1 612.91 ng·mg-1核蛋白)、D组(NF-κB ≥ 1 612.9 ng·mg-1核蛋白)。采用Kaplan-Meier生存曲线分析四组的全因死亡和CVD死亡的生存率。结果:四组间hsCRP、NT-proBNP以及糖尿病患病率具有差异有统计学意义,其中NF-κB水平最高的D组hsCRP和NT-proBNP明显高于A组、B组和C组(P均<0.05)。随访5年共有110例患者新发各类非致死性CVD,四组冠状动脉疾病、脑血管意外以及外周动脉闭塞发生率具有差异有统计学意义(P均<0.05),其中D组患者上述三种新发非致死CVD发生率均明显高于A组(P均<0.008);四组患者CVD病死率和全因死亡率具有差异有统计学意义(P均<0.05),D组生存率低于A组和B组(P均<0.05)。结论:外周血单个核细胞NF-κB水平和MHD患者CVD密切相关,NF-κB水平升高可增加CVD的发生率,且患者预后较差。

Objective:To investigate the relationships of NF-κB in cardiovascular disease (CVD) patients with maintenance hemodialysis (MHD), and to evaluate the effect of NF-kappa B on the prognosis of MHD patients. Methods:A total of 160 patients with end-stage renal failure receiving MHD treatment in our hospital in January 2012 and more than 6 months were selected as the subjects, and the NF-κB level was detected by ELISA. All patients were followed up for 5 years to record the new non-fatal CVD and the cause and time of death. According to NF-κB, the patients were divided into four groups, group A (NF-κB<750.82 ng·mg-1), group B (750.82 ng·mg-1 ≤ NF-κB<1 142.42 ng·mg-1), group C (1 142.42 ng·mg-1 ≤ NF-κB<1 612.91 ng·mg-1 nucleoprotein), group D (NF-κB<1 612.9 ng·mg-1). Kaplan-meier survival curve was used to analyze the survival rate of all four groups due to death and CVD death. Results:There were significant differences in hs-CRP, NT-proBNP and diabetes prevalence among the four groups, and hs-CRP and NT-proBNPin group D were significantly higher than those in group A, group B and group C (P<0.05). There were significant differences in the incidence of coronary artery diseases, cerebrovascular accidents and peripheral artery occlusion in all kinds of non-fatal CVD, patients followed up for 5 years. The incidence of non-lethal CVD in group D was significantly higher than that in group A (P<0.008). There were significant differences in CVD mortality and all-cause mortality among the four groups (P<0.05). The survival rate of D group was lower than that of group A and B (P<0.05). Conclusion:The level of NF-κ B in peripheral blood mononuclear cells is closely related to CVD in patients with MHD. The increase of NF-κ B level can increase the incidence of CVD, and the prognosis of the patients is poor.

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