Avram Morrell M, Fein Paul A, Paluch M Marut, Schloth Teresa, Chattopadhyay Jyotiprakas
Avram Division of Nephrology, Long Island College Hospital, Brooklyn, New York 11201, USA.
Adv Perit Dial. 2005;21:154-8.
An elevated level of C-reactive protein (CRP), which is a marker of inflammation, is a risk factor for morbidity and mortality in the general population and in dialysis patients. Recently, the relationship between inflammation and nutrition status has received much attention. Serum prealbumin is a highly sensitive marker of nutrition and survival in dialysis patients. The objective of the present study was to evaluate the prognostic value and clinical correlates of CRP in peritoneal dialysis (PD) patients. Using retrospective chart review, we collected demographic, clinical, and laboratory data on 66 PD patients for the period June 2001 to January 2005. High-sensitivity CRP (hs-CRP) levels were measured in a subgroup of 32 patients starting in May 2003. Over the study period, prealbumin and CRP were assayed serially by the immunoturbidimetric method. Mean age (+/- standard deviation) of the patients was 55 +/- 15 years, and 73% were African American. Mean and median enrollment CRP were 15.2 +/- 24 mg/L (range: 4.2 - 149.5 mg/L) and 6.45 mg/L respectively. Mean and median enrollment hs-CRP were 15.3 +/- 23.5 mg/L (range: 0.2 - 96 mg/L) and 6.55 mg/L respectively. Enrollment CRP was elevated (215 mg/L) in 29% of the patients, and hs-CRP was elevated (> or = mg/L) in 63% of the patients. Enrollment CRP was strongly correlated with hs-CRP (r = 0.7, p < 0.0001). The presence of diabetes (22 mg/L vs. 7.8 mg/L, p = 0.02), infection and inflammatory conditions (44.9 mg/L vs. 11.6 mg/L, p = 0.001), and lower levels of markers of nutrition such as prealbumin (r = -0.47, p < 0.0001) and creatinine (r = 0.35, p = 0.006) were associated with a higher level of CRP. Enrollment hs-CRP was a significant predictor of mortality in PD patients (relative risk = 1.044, p = 0.023). The observed cumulative survival (Kaplan-Meier) of patients with hs-CRP <15 mg/L was significantly better (p = 0.007) than was the survival of patients with a hs-CRP > or =15 mg/L. In a multivariate regression analysis, serum prealbumin was the best and only significant predictor of CRP level (beta = -0.37, p = 0.005). Elevated CRP was associated with infection and inflammation. Therefore, routine testing of hs-CRP in PD patients should be considered.
C反应蛋白（CRP）水平升高是炎症的一个标志物，在普通人群和透析患者中都是发病和死亡的危险因素。最近，炎症与营养状况之间的关系受到了广泛关注。血清前白蛋白是透析患者营养和生存的高度敏感标志物。本研究的目的是评估CRP在腹膜透析（PD）患者中的预后价值及临床相关性。通过回顾性病历审查，我们收集了2001年6月至2005年1月期间66例PD患者的人口统计学、临床和实验室数据。从2003年5月开始，对32例患者的亚组测量了高敏CRP（hs-CRP）水平。在研究期间，采用免疫比浊法连续检测前白蛋白和CRP。患者的平均年龄（±标准差）为55±15岁，73%为非裔美国人。入组时CRP的均值和中位数分别为15.2±24mg/L（范围：4.2 - 149.5mg/L）和6.45mg/L。入组时hs-CRP的均值和中位数分别为15.3±23.5mg/L（范围：0.2 - 96mg/L）和6.55mg/L。29%的患者入组时CRP升高（>215mg/L），63%的患者hs-CRP升高（≥mg/L）。入组时CRP与hs-CRP高度相关（r = 0.7，p < 0.0001）。糖尿病的存在（22mg/L对7.8mg/L，p = 0.02）、感染和炎症性疾病（44.9mg/L对11.6mg/L，p = 0.001）以及较低水平的营养标志物如前白蛋白（r = -0.47，p < 0.0001）和肌酐（r = 0.35，p = 0.006）与较高水平的CRP相关。入组时hs-CRP是PD患者死亡率的显著预测指标（相对风险 = 1.044，p = 0.023）。hs-CRP<15mg/L患者的观察到的累积生存率（Kaplan-Meier）显著优于hs-CRP≥15mg/L患者的生存率（p = 0.007）。在多变量回归分析中，血清前白蛋白是CRP水平的最佳且唯一显著预测指标（β = -0.37，p = 0.005）。CRP升高与感染和炎症相关。因此，应考虑对PD患者进行hs-CRP的常规检测。
