Menon Vandana, Wang Xuelei, Greene Tom, Beck Gerald J, Kusek John W, Marcovina Santica M, Levey Andrew S, Sarnak Mark J
Department of Medicine, Division of Clinical Care Research, Tufts-New England Medical Center, Boston, MA, USA.
Am J Kidney Dis. 2003 Jul;42(1):44-52. doi: 10.1016/s0272-6386(03)00407-4.
C-Reactive protein (CRP) level is elevated in kidney failure and may be related to malnutrition and cardiovascular disease (CVD). Data are limited regarding relationships between CRP levels and glomerular filtration rate (GFR), nutritional indices, and CVD in patients with earlier stages of kidney disease.
CRP was assayed from samples from the Modification of Diet in Renal Disease (MDRD) Study (n = 801). CRP distributions were compared between the MDRD Study and National Health and Nutrition Examination Survey (NHANES; 1999 to 2000). Associations between CRP level and GFR, nutritional indices, serum albumin levels, and CVD risk factors were examined in the MDRD Study.
Geometric means of CRP, adjusted for age and sex, were similar in NHANES (0.23 mg/dL) and the MDRD Study (0.22 mg/dL). In the MDRD Study, CRP level was related directly to measures of body fat and CVD risk factors, inversely with serum albumin level and energy intake, and unrelated to GFR. In multivariable analysis adjusting for other determinants of serum albumin level, high CRP level (>0.6 mg/dL) was associated with a 0.07-g/dL (0.7-g/L; 95% confidence interval [CI], 0.03 to 0.12) lower mean serum albumin level. After adjusting for traditional CVD risk factors, the odds of CVD were 1.73 (95% CI, 1.07 to 2.78) times greater in subjects with a high CRP level.
GFR level does not appear to influence CRP level in the earlier stages of chronic kidney disease. CRP levels are independently associated with serum albumin level and CVD prevalence. Inflammation may be involved in the pathophysiological state of malnutrition and CVD in the earlier stages of predominantly nondiabetic kidney disease.
肾功能衰竭时C反应蛋白（CRP）水平升高，可能与营养不良和心血管疾病（CVD）有关。关于CRP水平与肾病早期患者肾小球滤过率（GFR）、营养指标及CVD之间关系的数据有限。
从肾病饮食改良（MDRD）研究的样本（n = 801）中检测CRP。比较了MDRD研究与国家健康和营养检查调查（NHANES；1999至2000年）中CRP的分布情况。在MDRD研究中，研究了CRP水平与GFR、营养指标、血清白蛋白水平及CVD危险因素之间的关联。
经年龄和性别校正后，NHANES（0.23mg/dL）和MDRD研究（0.22mg/dL）中CRP的几何均值相似。在MDRD研究中，CRP水平与体脂测量值和CVD危险因素直接相关，与血清白蛋白水平和能量摄入呈负相关，与GFR无关。在对血清白蛋白水平的其他决定因素进行校正的多变量分析中，高CRP水平（>0.6mg/dL）与平均血清白蛋白水平降低0.07g/dL（0.7g/L；95%置信区间[CI]，0.03至0.12）相关。在对传统CVD危险因素进行校正后，CRP水平高的受试者发生CVD的几率高1.73倍（95%CI，1.07至2.78）。
在慢性肾病早期，GFR水平似乎不影响CRP水平。CRP水平与血清白蛋白水平和CVD患病率独立相关。炎症可能参与了以非糖尿病肾病为主的早期营养不良和CVD的病理生理状态。
