关键词: 血液透析, 心血管疾病, 血栓调节蛋白, 炎症因子, 颈动脉内中膜厚度

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To investigate the association of carotid atherosclerosis with thrombomodulin (Tm) and cytokines, and explore the influence on cardiovascular events in patients with maintenance hemodialysis (MHD).
Ｍｅｔｈｏｄｏｌｏｇｙ：A total of 108 stable MHD patients were enrolled into this study. The bilateral common carotid artery intimamedia thickness (cIMT) and carotid artery atheromatous plaque were measured by highresolution Bmode ultrasonography. Serum levels of Tm, cytokines (IL1β, IL6 and TNFα) were determined by ELISA. Correlation analysis of cIMT with Tm, cytokines and other parameters was performed. Logistic regression analysis was used to determine the risk factor of CVD in MHD patients with 12 months followup. The predictive value of cIMT and Tm for CVD were assessed using receiver operator characteristic (ROC) curve.
Ｒｅｓｕｌｔｓ：Increased cIMT was detected in 83 (769%) patients. Compared with the normal cIMT patients, plasma Tm concentration was significantly increased [(2043±322) mg/L vs (792±539) mg/L,P＜001] L in cIMT severe thickening patients, serum IL1β, IL6, TNFα and CRP levels were also significantly elevated. Compared with cIMT mild thickening patients, Tm concentration was obviously higher [(2043±322) mg/L vs (1092±432) mg/L,P＜001] and CRP, IL6 were obviously higher (P＜005) in cIMT severe thickening patients. Linear correlation analysis discovered that Tm concentration was positively correlated with IL1β, IL6, TNFα, CRP (P＜005 or P＜001 ). Multiple regression analysis indicated that Tm was independent positive correlate with cIMT (β=0620，t=5858，P＜0001). 12 months after followup, there were 51 newlyhappened cardiovascular events and 9 cases died. Logistic regression analysis found that increased cIMT (Wald=7639，OR=136，95%CI 1467～9258，P=0019) and Tm (Wald=8963，OR=104，95%CI  2272-5009，P=003) were risk factors to cardiovascular events. The area under the ROC curve (AUC) of cIMT for CVD was 0866 (95%CI 0794-0939,P=0001), cutoff value was 196 mm; The AUC of blood Tm for CVD was 0763 (95%CI 0664-0862,P=0003), cutoff value was 18635 mg/L.
Ｃｏｎｃｌｕｓｉｏｎ：
Vascular endothelial cell injury represented by Tm concentration and cIMT thickening were risk factors for cardiovascular events in MHD patients. Vascular endothelial cell injury and micro inflammatory reaction may promote the occurrence of atherosclerosis in MHD patients.

Key words: hemodialysis, cardiovascular disease, thrombomodulin, cytokines, carotid intima-media thickness