Furuya Ryuichi, Odamaki Mari, Kumagai Hiromichi, Hishida Akira
Department of Internal Medicine, Iwata City Hospital, Iwata, Japan.
Nephrol Dial Transplant. 2006 Feb;21(2):494-8. doi: 10.1093/ndt/gfi197. Epub 2005 Oct 12.
Leptin and adiponectin, well-recognized adipocytokines, are reported to contribute to the pathogenesis of atherosclerosis. The aim of this study was to elucidate the effects of icodextrin-based dialysis solution on adipocytokine metabolism.
In 12 non-diabetic anuric patients on peritoneal dialysis, dialysis solution was changed from glucose-based dialysis solution to icodextrin-based dialysis solution for 6 months. Plasma levels of leptin, adiponectin, lipids (total cholesterol, HDL-cholesterol and triglyceride), insulin, blood glucose and insulin sensitivity index by the homeostasis model assessment (HOMA-IR) were compared before and after the use of the icodextrin solution.
Plasma leptin level was decreased from 15.6 (2.5-69.0) to 7.3 (2.9-45.9) ng/ml (P = 0.018) and plasma adiponectin level increased from 11.6 (6.2-19.6) to 17.6 (7.8-33.0) microg/ml (P = 0.002). A reduction in plasma insulin level from 33.1 (13.8-54.1) to 19.1 (5.8-37.3) muU/ml (P = 0.009) and HOMA-IR from 8.22 (3.68-15.09) to 5.15 (1.40-13.78) (P = 0.015) was observed. While plasma total cholesterol level remained similar, HDL-cholesterol level increased, from 36.0 (22-45) to 43.5 (30-69) mg/dl (P = 0.008) and the triglyceride level decreased, from 174.0 (140-250) to 116.5 (81-207) mg/dl (P = 0.012).
Icodextrin-based dialysis solution improves abnormal adipocytokine metabolism, dyslipidaemia and insulin resistance, which are known to be associated with atherosclerosis. These results suggest that the use of icodextrin-based dialysis solution might be useful in preventing atherosclerosis in PD patients. Long-term effects of icodextrin-based dialysis solution on the atherosclerosis in peritoneal dialysis patients should be tested.
瘦素和脂联素是公认的脂肪细胞因子，据报道它们参与动脉粥样硬化的发病机制。本研究的目的是阐明基于艾考糊精的透析液对脂肪细胞因子代谢的影响。
对12例接受腹膜透析的非糖尿病无尿患者，将透析液从基于葡萄糖的透析液更换为基于艾考糊精的透析液，为期6个月。比较使用艾考糊精溶液前后血浆中瘦素、脂联素、脂质（总胆固醇、高密度脂蛋白胆固醇和甘油三酯）、胰岛素、血糖水平以及通过稳态模型评估（HOMA-IR）得出的胰岛素敏感性指数。
血浆瘦素水平从15.6（2.5 - 69.0）降至7.3（2.9 - 45.9）ng/ml（P = 0.018），血浆脂联素水平从11.6（6.2 - 19.6）升至17.6（7.8 - 33.0）μg/ml（P = 0.002）。观察到血浆胰岛素水平从33.1（13.8 - 54.1）降至19.1（5.8 - 37.3）mU/ml（P = 0.009），HOMA-IR从8.22（3.68 - 15.09）降至5.15（1.40 - 13.78）（P = 0.015）。虽然血浆总胆固醇水平保持相似，但高密度脂蛋白胆固醇水平升高，从36.0（22 - 45）升至43.5（30 - 69）mg/dl（P = 0.008），甘油三酯水平降低，从174.0（140 - 250）降至116.5（81 - 207）mg/dl（P = 0.012）。
基于艾考糊精的透析液可改善异常的脂肪细胞因子代谢、血脂异常和胰岛素抵抗，而这些已知与动脉粥样硬化相关。这些结果表明，使用基于艾考糊精的透析液可能有助于预防腹膜透析患者的动脉粥样硬化。应测试基于艾考糊精的透析液对腹膜透析患者动脉粥样硬化的长期影响。
