炎症与慢性肾病患者能量消耗增加有关。

Inflammation is associated with increased energy expenditure in patients with chronic kidney disease.

作者信息

Utaka Simone, Avesani Carla M, Draibe Sergio A, Kamimura Maria A, Andreoni Solange, Cuppari Lilian

机构信息

Nutrition Program, Federal University of São Paulo, São Paulo, Brazil.

出版信息

Am J Clin Nutr. 2005 Oct;82(4):801-5. doi: 10.1093/ajcn/82.4.801.

DOI:10.1093/ajcn/82.4.801

PMID:16210709

Abstract

BACKGROUND

Inflammation, a clinical condition observed in patients with chronic kidney disease (CKD), may be related to increased resting energy expenditure (REE).

OBJECTIVES

The main objective was to investigate the relation between inflammation and REE in patients with CKD who are not undergoing dialysis. We also aimed to analyze whether a decrease in C-reactive protein (CRP) would result in a reduction in REE.

DESIGN

This study enrolled 132 patients with CKD who were not undergoing dialysis, who had creatinine clearance from 5 to 65 mL.min(-1).1.73 m(-2), and who were 53.6 +/- 16 y old; 82 (62.1%) were men. Twenty-nine patients had clinical signs of infection. REE was measured by using indirect calorimetry, and inflammation was evaluated by using high-sensitivity CRP measurement. Patients were divided according to tertiles of CRP with the following intertertile ranges: first tertile, CRP < or = 0.14 mg/dL (n = 43); second tertile, CRP 0.15-0.59 mg/dL (n = 46); and third tertile, CRP > or = 0.60 mg/dL (n = 43). REE was measured before and after treatment in 10 patients who had inflammation or infection.

RESULTS

After adjustment for age, sex, and lean body mass, the REE of the third (1395 kcal/d; P = 0.02) and second (1355 kcal/d; P = 0.04) tertiles was significantly higher than that of the first tertile (1286 kcal/d). In the multiple linear regression analysis (n = 132), the independent determinants of REE were lean body mass, CRP, and age (R2 = 0.55). After treatment of infection in a subgroup of 10 patients, it was observed that a significant reduction in CRP concentration was accompanied by a significant reduction of 174 +/- 165 kcal that accounted for 13% of the initial REE.

CONCLUSION

This study showed that inflammation is associated with increased REE in patients with CKD.

摘要

背景

炎症是慢性肾脏病（CKD）患者中观察到的一种临床状况，可能与静息能量消耗（REE）增加有关。

目的

主要目的是研究未接受透析的CKD患者炎症与REE之间的关系。我们还旨在分析C反应蛋白（CRP）降低是否会导致REE减少。

设计

本研究纳入了132例未接受透析的CKD患者，其肌酐清除率为5至65 mL·min⁻¹·1.73 m⁻²，年龄为53.6±16岁；82例（62.1%）为男性。29例患者有感染的临床体征。通过间接测热法测量REE，通过高敏CRP测量评估炎症。根据CRP三分位数将患者分为以下三分位数范围：第一三分位数，CRP≤0.14 mg/dL（n = 43）；第二三分位数，CRP 0.15 - 0.59 mg/dL（n = 46）；第三三分位数，CRP≥0.60 mg/dL（n = 43）。对10例有炎症或感染的患者在治疗前后测量REE。

结果

在调整年龄、性别和瘦体重后，第三三分位数（1395 kcal/d；P = 0.02）和第二三分位数（1355 kcal/d；P = 0.04）的REE显著高于第一三分位数（1286 kcal/d）。在多元线性回归分析（n = 132）中，REE的独立决定因素是瘦体重、CRP和年龄（R² = 0.55）。在10例患者的亚组中治疗感染后，观察到CRP浓度显著降低，同时REE显著降低174±165 kcal，占初始REE的13%。