Paniagua Ramón, Frías Yolanda, de Ventura Maria Jesús, Rodríguez Ernesto, Hurtado María Elena, Alcántara Guadalupe, Vázquez Roberto, Ortiz Ruth, Salcedo Mario, Rios Maria Elena, Kaji Julio, Amato Dante
Unidad de Investigación Medica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Durango, Mexico.
Perit Dial Int. 2003 Mar-Apr;23(2):132-7.
Recently it has been pointed out that inflammation and infections caused by germs such as Chlamydia pneumoniae are independent cardiovascular risk factors for the general population, but information about these relationships in dialysis patients is scarce. This work was done to analyze the association of C-reactive protein (CRP) and IgG anti-Chlamydia pneumoniae antibodies (anti-Chlp-IgG) as independent cardiovascular risk factors in incident patients on continuous ambulatory peritoneal dialysis (CAPD).
Single-cohort, prospective observational study.
Three CAPD centers from the Instituto Mexicano del Seguro Social, and one from the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico.
A cohort of 75 adult incident patients on CAPD, without clinical signs of congestive heart failure, coronary heart disease, or peripheral arterial insufficiency. No restrictions for age, gender, or cause of renal failure were applied.
Mortality.
Demographic variables, body composition by electrical bioimpedance, serum glucose, urea, creatinine, lipids, homocysteine, nutritional markers (albumin, prealbumin, and transferrin), CRP, and anti-Chlp-IgG were measured and registered at the time of the first admission. When a patient died, the cause of death was determined by review of the clinical chart.
Mean follow-up time was 10.25 patient-months. There were 14 cardiovascular deaths. CRP was positive (> 10 mg/L) in 64% of the patients, and anti-Chlp-IgG in 64%; 29% of the patients were positive for both markers. The relative risk for cardiovascular mortality was 6.23 for patients positive for either CRP or anti-Chlp-IgG, and increased to 9.52 when both markers were positive. Multivariate analysis revealed that CRP and anti-Chlp-IgG were stronger cardiovascular death predictors than age, diabetes, and nutritional status.
These data suggest that inflammation and the presence of Chlamydia pneumoniae infections are important predictors of cardiovascular death in patients on CAPD.
最近有研究指出，肺炎衣原体等病菌引起的炎症和感染是普通人群独立的心血管危险因素，但关于透析患者中这些关系的信息却很少。本研究旨在分析C反应蛋白（CRP）和抗肺炎衣原体IgG抗体（抗Chlp-IgG）作为持续非卧床腹膜透析（CAPD）新发病例患者独立心血管危险因素的相关性。
单队列前瞻性观察研究。
墨西哥社会保险局的三个CAPD中心，以及墨西哥国家工人社会保障和服务局的一个中心。
75例CAPD成年新发病例患者组成的队列，无充血性心力衰竭、冠心病或外周动脉供血不足的临床症状。对年龄、性别或肾衰竭病因无限制。
死亡率。
在首次入院时测量并记录人口统计学变量、通过生物电阻抗法测定的身体成分、血清葡萄糖、尿素、肌酐、血脂、同型半胱氨酸、营养指标（白蛋白、前白蛋白和转铁蛋白）、CRP和抗Chlp-IgG。当患者死亡时，通过查阅临床病历确定死因。
平均随访时间为10.25患者月。有14例心血管死亡病例。64%的患者CRP呈阳性（>10mg/L），64%的患者抗Chlp-IgG呈阳性；29%的患者两种指标均呈阳性。CRP或抗Chlp-IgG呈阳性的患者心血管死亡的相对风险为6.23，当两种指标均呈阳性时，该风险增加至9.52。多变量分析显示，CRP和抗Chlp-IgG比年龄、糖尿病和营养状况更能预测心血管死亡。
这些数据表明，炎症和肺炎衣原体感染的存在是CAPD患者心血管死亡的重要预测因素。
