Cooper Bruce A, Penne Erik L, Bartlett Louise H, Pollock Carol A
Department of Renal Medicine, Kolling Institute, Royal North Shore Hospital, University of Sydney, St Leonards, NSW, Australia.
Am J Kidney Dis. 2004 Jan;43(1):61-6. doi: 10.1053/j.ajkd.2003.08.045.
It is proposed that chronic inflammation is common to the pathogenesis of malnutrition and vascular disease, both frequently observed in patients with end-stage renal disease. However, previous studies were unable to differentiate between true protein malnutrition and hypoalbuminemia.
This study was undertaken to determine the associations between malnutrition, measured by total-body nitrogen (TBN), and albumin, a marker of both nutritional status and chronic inflammation, with mortality and morbidity. One hundred nine patients starting dialysis therapy underwent nutritional assessment (TBN level and anthropometric measurements), vascular risk assessment (hypertension, hypercholesterolemia, diabetes mellitus, and smoking status), and serum albumin measurement. Subsequent patient mortality and new vascular events were recorded.
Survival was associated independently with both TBN (hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.1 to 2.5; P = 0.02 for every 10% decrease in nitrogen index) and serum albumin levels (HR, 1.1; 95% CI, 1.0 to 1.2; P = 0.004 for every 0.1-g/dL (1-g/L) decrease in serum albumin level) adjusted for other variables. Only low serum albumin level predicted subsequent vascular morbidity (HR, 2.2; 95% CI, 1.0 to 4.9; P = 0.049), as did increasing age (HR, 2.0; 95% CI, 1.4 to 3.0; P = 0.0004 for every 10-year increase in age) adjusted for other important risk factors.
This study dissociates the effect of protein malnutrition and hypoalbuminemia on morbidity and mortality in patients starting dialysis therapy. Protein malnutrition and hypoalbuminemia are independently predictive of mortality, whereas hypoalbuminemia is predictive of vascular morbidity. The study supports the hypothesis that hypoalbuminemia is pathogenically associated with vascular disease, but dissociates this effect from protein malnutrition.
有人提出，慢性炎症是营养不良和血管疾病发病机制的共同特征，这两种情况在终末期肾病患者中都很常见。然而，以往的研究无法区分真正的蛋白质营养不良和低白蛋白血症。
本研究旨在确定通过全身氮（TBN）衡量的营养不良与作为营养状况和慢性炎症标志物的白蛋白之间与死亡率和发病率的关联。109例开始透析治疗的患者接受了营养评估（TBN水平和人体测量）、血管风险评估（高血压、高胆固醇血症、糖尿病和吸烟状况）以及血清白蛋白测量。记录随后的患者死亡率和新的血管事件。
在对其他变量进行调整后，生存率与TBN（风险比[HR]，1.6；95%置信区间[CI]，1.1至2.5；氮指数每降低10%，P = 0.02）和血清白蛋白水平（HR，1.1；95%CI，1.0至1.2；血清白蛋白水平每降低0.1g/dL（1g/L），P = 0.004）均独立相关。只有低血清白蛋白水平预测了随后的血管发病率（HR，2.2；95%CI，1.0至4.9；P = 0.049），在对其他重要风险因素进行调整后，年龄增加也有同样的预测作用（HR，2.0；95%CI，1.4至3.0；年龄每增加10岁，P = 0.0004）。
本研究区分了蛋白质营养不良和低白蛋白血症对开始透析治疗患者发病率和死亡率的影响。蛋白质营养不良和低白蛋白血症独立预测死亡率，而低白蛋白血症预测血管发病率。该研究支持低白蛋白血症在发病机制上与血管疾病相关的假说，但将这种影响与蛋白质营养不良区分开来。
