Kaysen George A, Greene Tom, Daugirdas John T, Kimmel Paul L, Schulman Gerald W, Toto Robert D, Levin Nathan W, Yan Guofen
Veterans Affairs Northern California Health Care System, Mather, USA.
Am J Kidney Dis. 2003 Dec;42(6):1200-11. doi: 10.1053/j.ajkd.2003.08.021.
Loss of muscle mass and hypoalbuminemia each may result in part from either malnutrition, inflammation, or a combination of both. Short-term acidosis increases muscle protein catabolism and inhibits albumin synthesis.
We analyzed albumin and creatinine levels as outcome variables and their association with C-reactive protein (CRP) level, equilibrated normalized protein catabolic rate (enPCR), and serum bicarbonate level as independent variables from laboratory data obtained from patients in the Hemodialysis Study. Analyses controlled for race, sex, age, body mass index, and randomized treatment group.
Albumin level correlated with both enPCR and CRP level, but not serum bicarbonate level, in both cross-sectional and longitudinal analyses. Effects of CRP level and enPCR were not linear. Albumin level correlated positively with enPCR for an enPCR less than 1.0 g/kg/d, but not for a greater enPCR, and correlated inversely with CRP level for a CRP level greater than 13 mg/L. Similarly, creatinine level correlated with both enPCR and CRP level. As in the case of albumin level, effects were not linear. Creatinine level correlated positively with enPCR for values less than 1.0 g/kg/d, but not for greater enPCR values. In contrast to albumin level, creatinine level correlated negatively with serum bicarbonate level, even when adjusted for enPCR.
Albumin and creatinine levels are independently associated with nutrition (enPCR) and inflammation (CRP level). The cross-sectional relationship with enPCR is apparent only at values less than 1.0 g/kg/d. CRP level is associated with reduced albumin and creatinine values when increased to values greater than 5.6 mg/dL. CRP may be increased to levels associated with increased cardiovascular risk with little or no effect on either serum albumin or creatinine level. Thus, a normal albumin level does not exclude elevated CRP levels.
肌肉量减少和低白蛋白血症各自可能部分由营养不良、炎症或两者共同作用导致。短期酸中毒会增加肌肉蛋白分解代谢并抑制白蛋白合成。
我们分析了白蛋白和肌酐水平作为结果变量，以及它们与C反应蛋白（CRP）水平、平衡标准化蛋白分解代谢率（enPCR）和血清碳酸氢盐水平之间的关联，这些独立变量来自血液透析研究中患者的实验室数据。分析对种族、性别、年龄、体重指数和随机治疗组进行了控制。
在横断面和纵向分析中，白蛋白水平与enPCR和CRP水平均相关，但与血清碳酸氢盐水平无关。CRP水平和enPCR的影响并非呈线性。对于enPCR低于1.0 g/kg/d的情况，白蛋白水平与enPCR呈正相关，但对于更高的enPCR则不然；对于CRP水平高于13 mg/L的情况，白蛋白水平与CRP水平呈负相关。同样，肌酐水平与enPCR和CRP水平均相关。与白蛋白水平情况相同，影响并非呈线性。对于enPCR值低于1.0 g/kg/d的情况，肌酐水平与enPCR呈正相关，但对于更高的enPCR值则不然。与白蛋白水平相反，即使在调整enPCR后，肌酐水平与血清碳酸氢盐水平仍呈负相关。
白蛋白和肌酐水平分别与营养状况（enPCR）和炎症（CRP水平）相关。与enPCR的横断面关系仅在低于1.0 g/kg/d的值时明显。当CRP水平升高至大于5.6 mg/dL时，与白蛋白和肌酐值降低相关。CRP可能升高至与心血管风险增加相关的水平，而对血清白蛋白或肌酐水平几乎没有影响。因此，正常的白蛋白水平并不排除CRP水平升高。
