Joki Nobuhiko, Hase Hiroki, Tanaka Yuri, Takahashi Yasunori, Saijyo Tomokatsu, Ishikawa Hiroyaou, Inishi Yoji, Imamura Yoshihiko, Hara Hisao, Tsunoda Taro, Nakamura Masato
FJSIM, Division of Cardiology and Nephrology, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Tokyo 153-8515, Japan.
Nephrol Dial Transplant. 2006 Jun;21(6):1633-9. doi: 10.1093/ndt/gfl037. Epub 2006 Feb 17.
In patients with chronic kidney disease (CKD), although strong associations have been observed between malnutrition and atherosclerosis, the relationship between serum albumin concentration and angiographic changes of coronary artery disease (CAD) remains poorly explored. The goal of the present study was, in patients with CKD, to clarify the relationship between the angiographic severity of CAD and serum albumin concentration reflecting either inflammation or nutrition or both.
In this study, 100 end-stage renal disease (ESRD) patients were enrolled, who commenced long-term dialysis therapy at our hospital and underwent coronary angiography within 3 months of the first haemodialysis (HD) session. Mean age was 63+/-11 years, 20% of the subjects were female and 62% had diabetes. Severity of CAD was evaluated in terms of (i) number of vessels exhibiting CAD (>or=75% stenosis) and (ii) Gensini score (GS). Clinical characteristics and laboratory findings were recorded at initiation of long-term HD therapy. We then evaluated a possible association with the presence and degree of CAD.
Sixty-four patients exhibited signs of CAD. Forty-one among them (64%) had multivessel disease. On univariate logistic regression analysis, age, diabetes and hypoalbuminaemia were significantly associated with multivessel CAD. Univariate linear regression analysis demonstrated a positive correlation of age and diabetes with GS, and an inverse correlation of BMI and serum albumin level with GS. Stepwise regression analysis showed age and serum albumin level to be independently associated with multivessel CAD and GS. The ROC curves demonstrated best cut-off levels of age and albumin for predicting multivessel CAD to be 70 years and 3.15 g/dl, respectively.
Hypoalbuminaemia at the initiation of dialysis is an important predictor of advanced CAD, particularly in male and in diabetic patients. It may reflect mainly a state of inflammation. However, malnutrition as a confounding factor cannot be entirely excluded.
在慢性肾脏病（CKD）患者中，尽管已观察到营养不良与动脉粥样硬化之间存在密切关联，但血清白蛋白浓度与冠状动脉疾病（CAD）血管造影改变之间的关系仍未得到充分研究。本研究的目的是在CKD患者中，阐明CAD血管造影严重程度与反映炎症或营养或两者的血清白蛋白浓度之间的关系。
本研究纳入了100例终末期肾病（ESRD）患者，这些患者在我院开始长期透析治疗，并在首次血液透析（HD）治疗后3个月内接受了冠状动脉造影。平均年龄为63±11岁，20%的受试者为女性，62%患有糖尿病。根据以下方面评估CAD的严重程度：（i）出现CAD（狭窄≥75%）的血管数量；（ii）Gensini评分（GS）。在开始长期HD治疗时记录临床特征和实验室检查结果。然后评估其与CAD的存在和程度的可能关联。
64例患者表现出CAD迹象。其中41例（64%）患有多支血管病变。单因素逻辑回归分析显示，年龄、糖尿病和低白蛋白血症与多支血管CAD显著相关。单因素线性回归分析表明，年龄和糖尿病与GS呈正相关，BMI和血清白蛋白水平与GS呈负相关。逐步回归分析显示，年龄和血清白蛋白水平与多支血管CAD和GS独立相关。ROC曲线显示，预测多支血管CAD的年龄和白蛋白最佳截断水平分别为70岁和3.15 g/dl。
透析开始时的低白蛋白血症是晚期CAD的重要预测指标，尤其是在男性和糖尿病患者中。它可能主要反映炎症状态。然而，作为混杂因素的营养不良不能完全排除。
