Wang Xin, Axelsson Jonas, Nordfors Louise, Qureshi A Rashid, Avesani Carla, Barany Peter, Schalling Martin, Heimbürger Olof, Lindholm Bengt, Stenvinkel Peter
Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, K-56 Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden.
Nephrol Dial Transplant. 2007 Jan;22(1):196-202. doi: 10.1093/ndt/gfl504. Epub 2006 Sep 17.
A high body mass index (BMI) has been reported to confer a survival advantage in end-stage renal disease (ESRD) patients. On the other hand, body fat accumulation, especially visceral adipose tissue, is an important risk factor for cardiovascular disease, as well as a clinically important source of adipokines. Uncoupling protein 2 (UCP2) uncouples respiration from ATP synthesis, thus regulating energy expenditure and fat oxidation. In this longitudinal cohort study, we investigated the impact of the UCP2 insertion/deletion (ins/del) polymorphism on body composition changes in ESRD patients starting dialysis.
A total of 222 incident Caucasian ESRD patients (mean age 53 +/- 12 years; 60% males) were investigated close to the start of dialysis with peritoneal dialysis (PD; n = 126) or haemodialysis (HD; n = 96), and again after about 1 year (n = 159). Genotyping of the UCP2 ins/del polymorphism was performed in the patients and in 207 healthy controls. Dual-energy X-ray absorptiometry was conducted at baseline and after 1 year to monitor body composition.
While HD patients and PD patients with the ins/del genotype did not display any changes in body composition, the 48 PD patients with the del/del genotype that completed follow-up had a significant increase; DeltaBMI (0.7 +/- 1.8 kg/m(2)), Deltabody fat mass (3.5 +/- 3.8 kg) and Deltatruncal fat mass (1.7 +/- 1.2 kg). In a multiple linear regression analysis, the del/del genotype was an independent predictor of the increase in truncal fat mass in PD patients (F-ratio = 7.99, P < 0.05) together with age and diabetes mellitus.
PD patients, but not HD patients, with the UCP2 del/del genotype showed a significant increase in total and truncal fat mass during the first year of dialysis therapy, suggesting a possible role for UCP2 in dissipating the excess energy of a high-glucose environment.
据报道，高体重指数（BMI）可使终末期肾病（ESRD）患者具有生存优势。另一方面，体脂堆积，尤其是内脏脂肪组织，是心血管疾病的重要危险因素，也是脂肪因子的重要临床来源。解偶联蛋白2（UCP2）使呼吸与ATP合成解偶联，从而调节能量消耗和脂肪氧化。在这项纵向队列研究中，我们调查了UCP2插入/缺失（ins/del）多态性对开始透析的ESRD患者身体成分变化的影响。
共对222例初发的白种人ESRD患者（平均年龄53±12岁；60%为男性）进行了研究，这些患者在开始透析时接受腹膜透析（PD；n = 126）或血液透析（HD；n = 96），约1年后再次进行研究（n = 159）。对患者和207名健康对照进行UCP2 ins/del多态性基因分型。在基线和1年后进行双能X线吸收法检测以监测身体成分。
虽然具有ins/del基因型的HD患者和PD患者身体成分未显示任何变化，但完成随访的48例具有del/del基因型PD患者有显著增加；BMI变化值（0.7±1.8kg/m²）、体脂量变化值（3.5±3.8kg）和躯干脂肪量变化值（1.7±1.2kg）。在多元线性回归分析中，del/del基因型与年龄和糖尿病一起是PD患者躯干脂肪量增加的独立预测因素（F值 = 7.99，P < 0.05）。
具有UCP2 del/del基因型的PD患者而非HD患者在透析治疗第一年期间总脂肪量和躯干脂肪量显著增加，提示UCP2在消耗高糖环境中多余能量方面可能发挥作用。
