Bekpinar Selda, Unlüçerçi Yeşim, Genç Sema, Türkmen Aydin
Department of Biochemistry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
Adv Perit Dial. 2005;21:80-4.
In the present study, we used high sensitivity C-reactive protein (hs-CRP) analysis in combination with lipid screening [which has been reported to be a more valuable risk marker than other novel markers such as homocysteine (Hcy) and lipoprotein a] to perform cardiovascular risk assessment in peritoneal dialysis (PD) and hemodialysis (HD) patients. We selected 9 PD patients, 10 HD patients, and 9 control subjects for the study. In those patients, we determined levels of serum lipids, hs-CRP, Hcy, vitamin B12, folic acid, and leptin. Patients on PD had a significantly elevated hs-CRP concentration (3.14 +/- 0.79 mg/L) and ratio of total cholesterol (TC) to high density lipoprotein (HDL) cholesterol (4.71 +/- 0.40), and their cardiovascular risk was found to be three times that of control subjects. In HD patients, the elevation of hs-CRP was more profound (5.66 +/- 1.30), but their TC:HDL ratio fell within the normal range (3.18 +/- 0.13). However, a cardiovascular risk assessment of the HD group showed the same risk as in the PD group. Serum Hcy was also elevated in patients on PD (54.95 +/- 18.08 microl/L) and on HD (25.33 +/- 3.70 micromol/L) as compared with healthy subjects (13.76 +/- 0.94 micromol/L). Folic acid and vitamin B12 levels (needed to remethylate Hcy to methionine) were not compromised in the dialysis population. On the other hand, leptin secreted by adipose tissue was found to be mildly higher in PD patients (37.08 +/- 12.59 ng/mL). The mean leptin level in control subjects was 14.14 +/- 3.60 ng/mL. The proinflammatory and proangiogenic action of excess leptin may aggravate cardiovascular risk in PD patients. Increased values of known risk factors were found in dialysis patients on PD and on HD. However, lower levels of HDL cholesterol, higher cardiovascular risk assessment and Hcy levels, and mildly increased leptin levels seem to increase the potential threat of vascular disease in PD patients more than in HD patients.
在本研究中，我们将高敏C反应蛋白（hs-CRP）分析与血脂筛查相结合[据报道，血脂筛查是比同型半胱氨酸（Hcy）和脂蛋白a等其他新型标志物更有价值的风险标志物]，以对腹膜透析（PD）和血液透析（HD）患者进行心血管风险评估。我们选择了9名PD患者、10名HD患者和9名对照受试者进行研究。在这些患者中，我们测定了血脂、hs-CRP、Hcy、维生素B12、叶酸和瘦素的水平。PD患者的hs-CRP浓度（3.14±0.79mg/L）以及总胆固醇（TC）与高密度脂蛋白（HDL）胆固醇的比值（4.71±0.40）显著升高，并且发现他们的心血管风险是对照受试者的三倍。在HD患者中，hs-CRP的升高更为显著（5.66±1.30），但其TC:HDL比值在正常范围内（3.18±0.13）。然而，对HD组的心血管风险评估显示其风险与PD组相同。与健康受试者（13.76±0.94μmol/L）相比，PD患者（54.95±18.08μmol/L）和HD患者（25.33±3.70μmol/L）的血清Hcy也升高。透析人群中的叶酸和维生素B12水平（将Hcy重新甲基化为蛋氨酸所需的水平）未受影响。另一方面，发现脂肪组织分泌的瘦素在PD患者中略高（37.08±12.59ng/mL）。对照受试者的平均瘦素水平为14.14±3.60ng/mL。过量瘦素的促炎和促血管生成作用可能会加重PD患者的心血管风险。在PD和HD透析患者中发现已知风险因素的值升高。然而，HDL胆固醇水平较低、心血管风险评估和Hcy水平较高以及瘦素水平轻度升高似乎使PD患者比HD患者面临更大的血管疾病潜在威胁。
