The Detection Of Micro-inflammatory State In Chronic Renal Failure And Its Clinical Value

Background: Chronic renal failure is the result caused by renal chronic lesion originated by kinds of reasons and progressing aggravation. Lots of factors can deteriorate renal function. In recent years, the microinflammatory state in patients with CRF is increasingly concerned about. Micro-inflammatory state in patients with CRF is characterized with high level of serum inflammatory cytokines and acute reactive protein.The patients do not have significant clinical symptoms of infection. Clinical studies have shown that: Micro-inflammatory state may promote complications of CRF,like malnutrition,anemia and so on. It can deteriorate renal function. There was an obvious correction with the mortality and prognosis of patients.High-sensitivity C-reactive protein (CRP) can detect the micro- inflammatory state, it was considered the best indicator for micro- inflamma- tion.Recently some studies show that high-sensitivity C-reactive protein itself has a variety of biological activity that can further stimulate the secretion of inflammatory cytokines .Thus it will maintain the micro-inflammatory state.α2-macroglobulin (α2M) is a kind of broad-spectrum protease inhibitor,it take part in a variety of physiological functions through the regulation of endogenous or exogenous protease. When there is local inflammation, vascular permeability increased,α2-macroglobulin may enter organizations to combine with elastase and collagenase to prevent further damage to the organization.α2M may also combine with a number of small molecules such as cytokines, found in kidney tissue in the patients with primary glomerular diseases.It suggesting that the deposition ofα2M in kidney may contribute to local inflammation and immune damage.β2-microglobulin (β2m) is a low-molecular-weight protein,it is mainly synthesized by lymphocytes and tumor cells. After filtration by glomerular,β2m can almost entirely be reabsorpted by the proximal renal tubular cell and be degradated by lysosome into amino acids. The level of serumβ2m will increase when renal function is impaired.So the the concentration of blood can be used to reflect the glomerular filtration function.Objective: To observe the concentration of serum hs-CRP in pre-dialysis CRF patients. To explore the micro-inflammatory state in pre-dialysis CRF patients and the influence of micro-inflammatory state on malnutrition and the deterioration of renal function. Observe the concentration of serumβ2m to assess the significance ofβ2m for evaluation of renal function.Observe the change of albumin in serum to explore the relationship between micro-inflammation and malnutrition. Observe the concentration of serumα2-macroglobul and investigate its relationship with the micro-inflammatory state.Methods: 34 cases of pre-dialysis CRF patients were chosen as experimental group . 20 healthy people were chosen as control group . Gender and age matched between the experimental group and control group. Serumα2-M,β2m and hs-CRP were measured with DADE BEHRING–Ⅱautomatic biochemical analyzer and Scr,ALB were measured with Hitachi 7600-010 automatic biochemical analyzer.Results: Serum concentration of hs-CRP in pre-dialysis CRF patients (3.62±1.19mg/L)was higher than healthy control group(1.41±0.32mg/L),the difference was significant. Serum concentration of hs-CRP was positively correlated withβ2m and Scr. Serum concentration of hs-CRP was negatively correlated with ALB .There is no relation between hs-CRP andα2-M. Serum concentration ofβ2m in pre-dialysis CRF patients(21.97±8.94)was higher than healthy control group(1.67±0.58),the difference was significant. Serum concentration ofα-2M between the two group has no significient difference.Conclusion: 1,The micro-inflammatory state can be found in pre-dialysis CRF patients.2,The plasma levels ofβ2m was positively correlated with Scr.It can be used as auxiliary target to inspect renal function.3,The micro-inflammatory status in pre-dialysis CRF patients may deteriorate renal function.4,The micro-inflammatory state may contribute to the occurrence of malnutrition in pre-dialysis CRF patients.5,The plasma levels ofα2M in pre-dialysis CRF patients was normal, there is no correlation between hs-CRP andα2M.The study shows that The micro-inflammatory state can be found in pre-dialysis CRF patients and it can further promote the occurrence of malnutrition,the deterioration of renal function. To reduce and control the micro-inflammatory state will become the clinical treatment of CRF, it can improve the quality of life for CRF patients and reduce mortality. But the intervention of micro-inflammatory state and its assessment of intervention need more research.β2m was positively correlated with Scr, it can be used as supplementary indicators to assess the renal function. The concentration ofα2M between the two group shows no difference. Butα2M has a variety of physiological functions, the investigation for pathophysiological function ofα2-M in patients with CRF still needs further study.