Pecoits-Filho Roberto, Lindholm Bengt, Stenvinkel Peter
Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
Nephrol Dial Transplant. 2002;17 Suppl 11:28-31. doi: 10.1093/ndt/17.suppl_11.28.
The majority of patients starting dialysis already have signs of advanced atherosclerosis, and the risk factors for cardiovascular morbidity and mortality seen in patients with end-stage renal disease (ESRD) develop with the disease progression. Therefore, the predialysis period is the ideal time to start therapeutic interventions. Traditional risk factors alone may not adequately predict cardiovascular disease (CVD) outcome in patients with ESRD. Inflammation has been identified as playing a key role in atherosclerotic CVD. Pro-inflammatory cytokines are pivotal to the inflammation that is associated with malnutrition and atherosclerosis in ESRD. Malnutrition may worsen patient outcome by aggravating existing inflammation and heart failure, accelerating atherosclerosis and increasing susceptibility to infection. Atherosclerosis is itself a major risk factor for CVD mortality. Moreover, inflammation is associated with congestive heart failure. Strong associations between malnutrition, inflammation and atherosclerosis in this patient population suggest the presence of a syndrome we have called malnutrition, inflammation, and atherosclerosis (MIA), which is associated with an exceptionally high mortality rate.
大多数开始透析的患者已经出现晚期动脉粥样硬化的迹象，而终末期肾病（ESRD）患者中心血管发病和死亡的危险因素会随着疾病进展而出现。因此，透析前期是开始进行治疗干预的理想时机。仅传统危险因素可能无法充分预测ESRD患者的心血管疾病（CVD）结局。炎症已被确定在动脉粥样硬化性CVD中起关键作用。促炎细胞因子对于ESRD中与营养不良和动脉粥样硬化相关的炎症至关重要。营养不良可能会通过加重现有的炎症和心力衰竭、加速动脉粥样硬化以及增加感染易感性而使患者预后恶化。动脉粥样硬化本身就是CVD死亡的主要危险因素。此外，炎症与充血性心力衰竭相关。该患者群体中营养不良、炎症和动脉粥样硬化之间的强烈关联表明存在一种我们称为营养不良、炎症和动脉粥样硬化（MIA）的综合征，其与极高的死亡率相关。
