Yao Q, Axelsson J, Heimburger O, Stenvinkel P, Lindholm B
Division of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institutet, Stockholm, Sweden.
Minerva Urol Nefrol. 2004 Sep;56(3):237-48.
Despite rapid improvements in dialysis technology during the last 20 years, the mortality rate in end-stage renal disease (ESRD) patients treated with dialysis is still unacceptably high and comparable to that of many cancer patients with metastases. The main cause of the increased mortality in ESRD patients is cardiovascular disease (CVD), which is twice as common and advances at twice the rate already in patients with earlier stages of chronic kidney disease as compared to the general population. Although traditional risk factors are common in dialysis patients, they can only in part explain the very high prevalence of CVD in this patient group. Recent evidence demonstrates that chronic inflammation, a non-traditional risk factor which is a commonly observed in dialysis patients, may cause malnutrition and progressive atherosclerotic CVD by several pathogenetic mechanisms. Available data suggest that pro-inflammatory cytokines play a central role in the genesis of both malnutrition and CVD in ESRD. While the long-term effects of chronic inflammation may be most important in the pathogenesis of CVD, the acute-phase reaction may also be a direct cause of acute vascular injury by several pathogenetic mechanisms. The cause(s) of inflammation in dialysis are multifactorial and include both dialysis-related and unrelated factors. Thus, it could be speculated that suppression of the vicious cycle of malnutrition, inflammation, and atherosclerosis (MIA syndrome) would improve survival in dialysis patients. As there are currently no established guidelines for the treatment of chronic inflammation in ESRD patients, studies on the long-term effects of various anti-inflammatory treatment strategies on the nutritional and cardiovascular status as well as outcome in this patient group are warranted.
尽管在过去20年里透析技术有了迅速进步，但接受透析治疗的终末期肾病（ESRD）患者的死亡率仍然高得令人无法接受，与许多有转移的癌症患者相当。ESRD患者死亡率增加的主要原因是心血管疾病（CVD），在慢性肾病早期患者中，CVD的发生率是普通人群的两倍，进展速度也是普通人群的两倍。虽然传统风险因素在透析患者中很常见，但它们只能部分解释该患者群体中CVD的极高患病率。最近的证据表明，慢性炎症是透析患者中常见的非传统风险因素，可能通过多种致病机制导致营养不良和进行性动脉粥样硬化性CVD。现有数据表明，促炎细胞因子在ESRD患者营养不良和CVD的发生中起核心作用。虽然慢性炎症的长期影响在CVD发病机制中可能最为重要，但急性期反应也可能通过多种致病机制直接导致急性血管损伤。透析中炎症的原因是多因素的，包括与透析相关和不相关的因素。因此，可以推测抑制营养不良、炎症和动脉粥样硬化的恶性循环（MIA综合征）将提高透析患者的生存率。由于目前尚无针对ESRD患者慢性炎症治疗的既定指南，因此有必要开展研究，探讨各种抗炎治疗策略对该患者群体营养和心血管状况以及预后的长期影响。
