【摘要】目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者Nod 样受体蛋白3/白细胞介素-1β(Nod-like receptor protein 3/interleukin 1β,NLRP3/IL-1β)信号通路活化与高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)水平及动脉粥样硬化(atherosclerosis, AS)发生的关系。方法行MHD 治疗的患者83 例为研究组，20 例健康人为对照组，检测生化指标、HDL-C、血白细胞介素(IL)-1β、IL-18 及外周血单核细胞NLRP3mRNA；测定颈动脉内膜中层厚度(intimamedia thickness,IMT)。比较2 组间上述指标的差异；分析HDL-C及颈动脉IMT与NLRP3mRNA、IL-1β及IL-18的相关性；明确影响MHD患者HDL-C水平及颈动脉IMT的危险因素。结果研究组MHD患者HDL-C低于对照组(t=-7.048, P<0.001)，颈动脉IMT值大于对照组(t=2.634, P<0.001)；血HDL-C与NLRP3mRNA ( r=-0.682, P<0.001)、IL-1β(r=-0.537, P<0.001)及IL-18(r=-0.426, P<0.001)呈负相关；颈动脉IMT与NLRP3mRNA (r= 0.521，P＜0.001)、IL-1β(r=0.569，P＜0.001)及IL-18(r=0.674，P＜0.001)成正相关；NLRP3mRNA 活化是HDL-C 降低的危险因素(B=-0.390，p＜0.001)，而NLRP3mRNA、IL-18 活化(B=0.069、0.002，均P＜0.001)及HDL- C 降低(B=- 0.106，P＜0.001)是MHD 患者颈动脉IMT 增厚的危险因素。结论NLRP3/IL-1β 信号通路参与了MHD患者血HDL-C 水平降低及颈动脉IMT 增厚。
【Abstract】Objective To investigate the relationship between of Nod-like receptor protein 3/interleukin-1β (NLRP3/IL-1β) signaling pathway activation and blood high-density lipoprotein cholesterol (HDL-C) level and atherosclerosis (AS) in patients with maintenance hemodialysis (MHD). Methods A total of 83 patients who underwent MHD were collected as the study group, and 20 healthy individuals as the control group. Their biochemical indexes, HDL-C, serum IL-1β, interleukin-18 (IL-18) and NLRP3 mRNA were assayed, and the carotid intima-media thickness (IMT) was measured. The differences of these results were compared
between the two groups. The correlations between HDL-C and NLRP3 mRNA, carotid artery IMT and NLRP3 mRNA, and IL-1β and IL-18 were analyzed respectively. The risk factors affecting HDL-C level and carotid IMT in MHD patients were explored. Results HDL-C level was lower in MHD patients than in the control group (t=-7.048，P<0.001), while carotid IMT value was higher in MHD patients than in the control group (t=2.634，P<0.001). HDL- C was negatively correlated with NLRP3 mRNA (r=- 0.682, P<0.001), IL- 1β (r=-0.537, P<0.01) and IL-18 (r=-0.426, P<0.01). Carotid artery IMT was positively correlated with NLRP3 mRNA (r=0.521, P<0.001), IL-1β (r=0.569, P<0.001) and IL-18 (r=0.674, P<0.001). Hence, the activation of NLRP3 mRNA was the risk factor for low HDL-C level (B=-0.390, P<0.001), while the activation of NLRP3 mRNA (B=0.069, P<0.001) and IL-18 signals (B=0.002, P< 0.001) and the decrease of HDL-C (B=-0.106, P<0.001) were the risk factors for the increase of carotid IMT in MHD patients. Conclusion NLRP3/IL-1β signal pathway is involved in the decrease of blood HDL-C level and the thickening of carotid artery IMT in
MHD patients.
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