Afzali Behdad, Bakri Rached S, Bharma-Ariza Paul, Lumb Peter J, Dalton Neil, Turner Neil C, Wierzbicki Anthony S, Crook Martin A, Goldsmith David J
Nephrology and Transplantation, Guy's Hospital, London, UK.
J Nephrol. 2003 Jul-Aug;16(4):540-5.
Cardiovascular disease (CVD) rates in dialysis patients are very high. One of the many associated risk factors is chronic inflammation. The relationship of baseline markers of chronic inflammation with the presence of CVD was assessed in a large cohort of stable dialysis patients. Median time (IQR) on dialysis treatment was 20(9-52) months. Forty-one patients had CVD (as defined by the history / clinical presence of ischemic heart disease, peripheral vascular disease, or cerebrovascular disease). Patients with CVD were significantly older than patients without (67 + /- 11 vs. 54 + /- 10 yrs, p < 0.03). Time from dialysis, urea reduction ratio (hemodialysis only) and smoking history were similar between the two groups. Patients with CVD had significantly higher levels of sialic acid (SA) (91.2 +/- 24.2 vs. 82.0 + /- 18.2 mg/dL, p = 0.03). Body weight, plasma fibrinogen, C-reactive protein (CRP), homocysteine, creatinine, total-, LDL (low density lipoprotein)-, or HDL (high density lipoprotein)-cholesterol, systolic, diastolic and pulse pressures did not differ between the CVD and CVD(-) groups. Patients on chronic ambulatory peritoneal dialysis (CAPD) had more elevated lipid fractions, inflammatory markers, and SA levels than did patients on hemodialysis (HD). The presence of diabetes, the use of lipid-lowering therapy, and smoking history was not associated with any difference in SA levels. In contrast to C-reactive protein (CRP) concentrations, SA levels were unaffected by the hemodialysis session. SA was strongly correlated with CRP (r = 0.59, p < 0.0001), but not with patient age, any measure of blood pressure (BP), urea reduction ratio, plasma creatinine, lipid fractions or homocysteine. Levels of the chronic inflammation marker sialic acid correlate strongly with CRP and are increased in patients with cardiovascular disease, but show no relationship to hemodialysis session. Thus sialic acid may be a superior marker to CRP for assessment of chronic inflammation in patients undergoing dialysis.
透析患者的心血管疾病（CVD）发生率非常高。众多相关危险因素之一是慢性炎症。在一大群稳定的透析患者中评估了慢性炎症的基线标志物与CVD存在之间的关系。透析治疗的中位时间（四分位间距）为20（9 - 52）个月。41例患者患有CVD（根据缺血性心脏病、外周血管疾病或脑血管疾病的病史/临床存在情况定义）。患有CVD的患者明显比未患CVD的患者年龄大（67±11岁对54±10岁，p < 0.03）。两组之间的透析时间、尿素清除率（仅血液透析）和吸烟史相似。患有CVD的患者唾液酸（SA）水平显著更高（91.2±24.2对82.0±18.2mg/dL，p = 0.03）。CVD组和非CVD组之间的体重、血浆纤维蛋白原、C反应蛋白（CRP）、同型半胱氨酸、肌酐、总胆固醇、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）胆固醇、收缩压、舒张压和脉压没有差异。与血液透析（HD）患者相比，持续性非卧床腹膜透析（CAPD）患者的脂质组分、炎症标志物和SA水平升高更多。糖尿病的存在、降脂治疗的使用和吸烟史与SA水平的任何差异均无关。与C反应蛋白（CRP）浓度不同，SA水平不受血液透析疗程的影响。SA与CRP强烈相关（r = 0.59，p < 0.0001），但与患者年龄、任何血压（BP）测量值、尿素清除率、血浆肌酐、脂质组分或同型半胱氨酸均无关。慢性炎症标志物唾液酸水平与CRP密切相关，在心血管疾病患者中升高，但与血液透析疗程无关。因此，唾液酸可能是评估透析患者慢性炎症优于CRP的标志物。
