慢性肾衰竭患者白蛋白和纤维蛋白原合成率增加。

Increased albumin and fibrinogen synthesis rate in patients with chronic renal failure.

作者信息

Prinsen Berthil H C M T, Rabelink Ton J, Beutler Jaap J, Kaysen George A, De Boer Jose, Boer Walther H, Hagen E Christiaan, Berger Ruud, De Sain-Van Der Velden Monique G M

机构信息

Department of Vascular Medicine and Metabolism, University Medical Center Utrecht, Utrecht, The Netherlands.

出版信息

Kidney Int. 2003 Oct;64(4):1495-504. doi: 10.1046/j.1523-1755.2003.00211.x.

DOI:10.1046/j.1523-1755.2003.00211.x

PMID:12969171

Abstract

BACKGROUND

Hypoalbuminemia and hyperfibrinogenemia are frequently observed in patients with chronic renal failure (CRF) and are both associated with cardiovascular diseases. The mechanisms responsible for hypoalbuminemia and hyperfibrinogenemia in CRF are unknown.

METHODS

In the present study, both albumin and fibrinogen kinetics were measured in vivo in predialysis patients (N = 6), patients on peritoneal dialysis (N = 7) and control subjects (N = 8) using l-[1-13C]-valine.

RESULTS

Plasma albumin concentration was significantly lower in patients on peritoneal dialysis compared to control subjects (P < 0.05). Plasma fibrinogen was significantly increased in both predialysis patients (P < 0.01) as well as patients on peritoneal dialysis (P < 0.001) in comparison to control subjects. In contrast to albumin, fibrinogen is only lost in peritoneal dialysate and not in urine. The absolute synthesis rates (ASR) of albumin and fibrinogen were increased in patients on peritoneal dialysis (ASR albumin, 125 +/- 9 mg/kg/day versus 93 +/- 9 mg/kg/day, P < 0.05; ASR fibrinogen, 45 +/- 4 mg/kg/day versus 29 +/- 3 mg/kg/day, P < 0.01) compared to control subjects. Albumin synthesis is strongly correlated with fibrinogen synthesis (r2 = 0.665, P < 0.0001, N = 21). In this study, the observed hypoalbuminemia in patients on peritoneal dialysis is likely not explained by malnutrition, inadequate dialysis, inflammation, metabolic acidosis, or insulin resistance. We speculate that peritoneal albumin loss is of relevance.

CONCLUSION

Synthesis rate of albumin and fibrinogen are coordinately up-regulated. Both albumin and fibrinogen are lost in peritoneal dialysis fluid. To compensate protein loss, albumin synthesis is up-regulated, but the response, in contrast to predialysis patients, does not fully correct plasma albumin concentrations in peritoneal dialysis patients. The increase in fibrinogen synthesis introduces an independent risk factor for atherosclerosis, since plasma fibrinogen pool is enlarged.

摘要

背景

低白蛋白血症和高纤维蛋白原血症在慢性肾衰竭（CRF）患者中经常出现，且均与心血管疾病相关。CRF患者发生低白蛋白血症和高纤维蛋白原血症的机制尚不清楚。

方法

在本研究中，使用l-[1-13C]-缬氨酸在体内测量了未透析患者（N = 6）、腹膜透析患者（N = 7）和对照受试者（N = 8）的白蛋白和纤维蛋白原动力学。

结果

与对照受试者相比，腹膜透析患者的血浆白蛋白浓度显著降低（P < 0.05）。与对照受试者相比，未透析患者（P < 0.01）和腹膜透析患者（P < 0.001）的血浆纤维蛋白原均显著升高。与白蛋白不同，纤维蛋白原仅在腹膜透析液中丢失，而不在尿液中丢失。与对照受试者相比，腹膜透析患者的白蛋白和纤维蛋白原绝对合成率（ASR）增加（ASR白蛋白，125±9mg/kg/天对93±9mg/kg/天，P < 0.05；ASR纤维蛋白原，45±4mg/kg/天对29±3mg/kg/天，P < 0.01）。白蛋白合成与纤维蛋白原合成密切相关（r2 = 0.665，P < 0.0001，N = 21）。在本研究中，腹膜透析患者中观察到的低白蛋白血症可能无法用营养不良、透析不充分、炎症、代谢性酸中毒或胰岛素抵抗来解释。我们推测腹膜白蛋白丢失具有相关性。