巴西血液透析患者中C反应蛋白水平波动的预后影响：一项前瞻性研究。

The prognostic impact of fluctuating levels of C-reactive protein in Brazilian haemodialysis patients: a prospective study.

作者信息

Nascimento Marcelo M, Pecoits-Filho Roberto, Qureshi A Rashid, Hayashi Shirley Y, Manfro Roberto C, Pachaly Maria A, Renner Luciana, Stenvinkel Peter, Lindholm Bengt, Riella Miguel C

机构信息

Division of Renal Medicine, Department of Clinical Science, Karolinska Institutet, Karolinka University Hospital Huddinge, Stockholm, Sweden.

出版信息

Nephrol Dial Transplant. 2004 Nov;19(11):2803-9. doi: 10.1093/ndt/gfh493.

DOI:10.1093/ndt/gfh493

PMID:15496560

Abstract

BACKGROUND

A single elevated C-reactive protein (CRP) value predicts mortality in haemodialysis (HD) patients, but the relative importance of repeated vs occasional positive systemic inflammatory response findings is not known.

METHODS

To assess the influence on survival of occasional inflammation, CRP, serum albumin (S-Alb) and fibrinogen were analysed bimonthly in 180 HD patients (54% male, 49+/-14 years). Clinically significant inflammation was defined as CRP >5.1 mg/l, based on the receiver operating characteristics curve for CRP as predictor of death. Based on four consecutive measurements of CRP, patients were assigned into three groups: group 1 (n = 74; 41%), no inflammation (CRP < or = 5.1 mg/l in all measurements); group 2 (n = 65; 36%), occasional inflammation (1-3 measurements of CRP > 5.1 mg/l); and group 3 (n = 41; 23%), persistent inflammation (all measurements of CRP >5.1 mg/l). The nutritional status was evaluated by subjective global assessment (SGA) and body mass index (BMI), and the survival (21 months of follow-up) by Kaplan-Meier curve and Cox model.

RESULTS

The median and range of CRP values (mg/l) for group 1, 2 and 3 were: 3.2 (3.2-5.1), 3.6 (3.2-54.9) and 13.8 (5.2-82), respectively (P<0.001), whereas the prevalence of malnutrition, assessed by SGA and BMI, did not differ significantly between the groups. The survival rate by Kaplan-Meier analysis was significantly different among the groups (chi2 = 12.34; P = 0.0004). Patients in group 3 showed the highest mortality (34%; P = 0.001), compared with group 1 (8%) and group 2 (14%; P = 0.01), respectively, whereas there was no significant difference in mortality between groups 1 and 2. Age, CRP, S-Alb level and SGA were independent predictors of mortality.

CONCLUSION

The patients with a persistent elevation of CRP had a higher mortality rate than the patients with occasional CRP elevation. Thus, persistent, rather than occasional, inflammation is an important predictor of death in HD patients.

摘要

背景

单次C反应蛋白（CRP）升高可预测血液透析（HD）患者的死亡率，但重复出现与偶尔出现的全身炎症反应阳性结果的相对重要性尚不清楚。

方法

为评估偶尔发生的炎症对生存率的影响，对180例HD患者（男性占54%，年龄49±14岁）每两个月分析一次CRP、血清白蛋白（S-Alb）和纤维蛋白原。基于CRP作为死亡预测指标的受试者工作特征曲线，将具有临床意义的炎症定义为CRP>5.1mg/l。根据连续四次CRP测量结果，将患者分为三组：第1组（n=74；41%），无炎症（所有测量中CRP≤5.1mg/l）；第2组（n=65；36%），偶尔有炎症（1-3次测量中CRP>5.1mg/l）；第3组（n=41；23%），持续炎症（所有测量中CRP>5.1mg/l）。通过主观全面评定法（SGA）和体重指数（BMI）评估营养状况，通过Kaplan-Meier曲线和Cox模型评估生存率（随访21个月）。

结果

第1、2和3组CRP值（mg/l）的中位数及范围分别为：3.2（3.2-5.1）、3.6（3.2-54.9）和13.8（5.2-82）（P<0.001），而通过SGA和BMI评估的营养不良患病率在各组间无显著差异。通过Kaplan-Meier分析得出的生存率在各组间有显著差异（χ2=12.34；P=0.0004）。第3组患者的死亡率最高（34%；P=0.001），分别与第1组（8%）和第2组（14%；P=0.01）相比，而第1组和第2组之间的死亡率无显著差异。年龄、CRP、S-Alb水平和SGA是死亡率的独立预测因素。