Chertow G M, Ackert K, Lew N L, Lazarus J M, Lowrie E G
Divisions of Nephrology, Moffitt-Long Hospitals and UCSF-Mt. Zion Medical Center, and Departments of Medicine and Nutrition, University of California, San Francisco, California 94143-0532, USA.
Kidney Int. 2000 Dec;58(6):2512-7. doi: 10.1046/j.1523-1755.2000.00435.x.
Although serum prealbumin is considered a valid indicator of nutritional status in hemodialysis patients, there is relatively little evidence that its determination is of major prognostic significance. In this study, we aimed to determine the independent association of serum prealbumin with survival in hemodialysis patients, after adjusting for serum albumin and other indicators of protein energy nutritional status.
Serum prealbumin was measured in more than 1600 maintenance hemodialysis patients. We determined the correlations among prealbumin and other indicators of nutritional status, including serum albumin, and bioimpedance-derived indicators of body composition. The relationship between serum prealbumin and survival was determined using proportional hazards regression.
The serum albumin was directly correlated with the serum prealbumin (r = 0.47, P < 0.0001), but still explained <25% of the variability in prealbumin. Prealbumin was inversely related to mortality, with a relative risk reduction of 6% per 1 mg/dL increase in prealbumin, even after adjusting for case mix, serum albumin, and other nutritional indicators. The increase in risk with lower serum prealbumin concentrations was observed whether the serum albumin was high or low.
In hemodialysis patients, the serum prealbumin provides prognostic value independent of the serum albumin and other established predictors of mortality in this population.
尽管血清前白蛋白被认为是血液透析患者营养状况的有效指标，但相对较少有证据表明其测定具有重大的预后意义。在本研究中，我们旨在确定在调整血清白蛋白和蛋白质能量营养状况的其他指标后，血清前白蛋白与血液透析患者生存率之间的独立关联。
对1600多名维持性血液透析患者测定血清前白蛋白。我们确定了前白蛋白与其他营养状况指标之间的相关性，包括血清白蛋白以及生物电阻抗法得出的身体成分指标。使用比例风险回归确定血清前白蛋白与生存率之间的关系。
血清白蛋白与血清前白蛋白直接相关（r = 0.47，P < 0.0001），但仍只能解释前白蛋白变异性的不到25%。前白蛋白与死亡率呈负相关，即使在调整病例组合、血清白蛋白和其他营养指标后，前白蛋白每增加1mg/dL，相对风险降低6%。无论血清白蛋白水平高或低，血清前白蛋白浓度较低时风险都会增加。
在血液透析患者中，血清前白蛋白具有独立于血清白蛋白和该人群其他既定死亡率预测指标的预后价值。
