Healy H, Reith D, Morgan C, Clague A, Westhuyzen J
Department of Renal Medicine, Royal Brisbane Hospital, Queensland, Australia.
Ann Clin Lab Sci. 2000 Jul;30(3):295-304.
End-stage renal failure (ESRF) is associated with a higher risk of cardiovascular disease (CVD) than predicted by the major risk factors. We investigate the hypothesis that metalloproteins such as transferrin and ceruloplasmin and the inflammatory response are associated with CVD risk in this population. In this cross-sectional study of 81 subjects stable on haemodialysis (HD), 43 with CVD and/or peripheral vascular disease (PAD) were compared to 38 subjects without clinical evidence of CVD/PAD. Serum concentrations of metalloproteins and acute phase reactants were compared by univariate analysis and logistic regression modelling. Body mass index, gender ratios, prevalence of diabetes, iron status, and homocysteine concentrations did not differ significantly between the groups. Those with CVD were older (P< 0.001) and had been on dialysis for longer (P = 0.004). CVD subjects had significantly higher concentrations of ceruloplasmin (325 vs 284 mg/L, P = 0.011), copper (18.2 vs 15.7 micromol/L, P = 0.002), and C-reactive protein (CRP) (median 9.0 vs 3.8 mg/L, P = 0.002). Transferrin iron binding capacity tended to be higher in the CVD group (P = 0.088). CVD risk for subjects with serum concentrations in the upper tertile was increased 9.4-fold (CI 2.8-31.0) for copper, 4.2-fold (CI 1.5-12.2) for ceruloplasmin, 3.9-fold (CI 1.3-12.1) for transferrin iron binding capacity, and 2.3-fold (CI 0.9-6.1) for CRP. In multivariate logistic regression models, age (P = 0.001) and time on dialysis (P = 0.002) were the strongest risk factors for CVD. After adjustment for age and time on dialysis, transferrin iron binding capacity (P = 0.013) and copper (P = 0.019) continued to be associated with CVD risk but ceruloplasmin (P = 0.065) and CRP (P = 0.634) were not. Total cholesterol was associated with a lower risk of CVD (ie protective), presumably due to cholesterol-lowering therapy in high-risk patients. In conclusion, copper and transferrin iron binding capacity may be associated with CVD risk in HD subjects.
终末期肾衰竭（ESRF）患者患心血管疾病（CVD）的风险高于主要危险因素所预测的风险。我们研究了这样一个假设，即诸如转铁蛋白和铜蓝蛋白等金属蛋白以及炎症反应与该人群的CVD风险相关。在这项对81名维持性血液透析（HD）稳定的受试者的横断面研究中，将43名患有CVD和/或外周血管疾病（PAD）的受试者与38名无CVD/PAD临床证据的受试者进行了比较。通过单因素分析和逻辑回归模型比较了金属蛋白和急性期反应物的血清浓度。两组之间的体重指数、性别比例、糖尿病患病率、铁状态和同型半胱氨酸浓度无显著差异。患有CVD的受试者年龄较大（P<0.001），透析时间更长（P = 0.004）。CVD受试者的铜蓝蛋白（325 vs 284 mg/L，P = 0.011）、铜（18.2 vs 15.7 μmol/L，P = 0.002）和C反应蛋白（CRP）（中位数9.0 vs 3.8 mg/L, P = 0.002）浓度显著更高。CVD组的转铁蛋白铁结合能力有升高趋势（P = 0.088）。血清浓度处于上三分位数的受试者，铜导致的CVD风险增加9.4倍（CI 2.8 - 31.0），铜蓝蛋白导致的风险增加4.2倍（CI 1.5 - 12.2），转铁蛋白铁结合能力导致的风险增加3.9倍（CI 1.3 - 12.1），CRP导致的风险增加2.3倍（CI 0.9 - 6.1）。在多变量逻辑回归模型中，年龄（P = 0.001）和透析时间（P = 0.002）是CVD最强的危险因素。在调整年龄和透析时间后，转铁蛋白铁结合能力（P = 0.013）和铜（P = 0.019）仍与CVD风险相关，但铜蓝蛋白（P = 0.065）和CRP（P = 0.634）则不然。总胆固醇与较低的CVD风险相关（即具有保护作用），可能是由于对高危患者进行了降胆固醇治疗。总之，铜和转铁蛋白铁结合能力可能与HD受试者的CVD风险相关。
