Fontán Miguel Pérez, Máñez Rafael, Rodríguez-Carmona Ana, Peteiro Javier, Martínez Verónica, García-Falcón Teresa, Domenech Nieves
Division of Nephrology and Laboratory of Biochemistry, Hospital Juan Canalejo, Xubias 84, 15006 A Coruña, Spain.
Am J Kidney Dis. 2006 Dec;48(6):972-82. doi: 10.1053/j.ajkd.2006.08.027.
Anti-Galalpha1-3Gal antibodies (anti-alphaGal) represent a significant fraction of natural antibodies and were implicated in several disease states, yet their origin and physiological significance remain largely undisclosed.
Under a prospective observational design, we estimated anti-alphaGal immunoglobulin G (IgG)/IgM and antipig hemolytic antibody (APA) levels in 133 patients starting dialysis therapy and again after a 1-year follow-up. We used baseline data to show correlations with demographic, nutritional, inflammatory, and anemia markers and analyzed their correlation with outcomes by using univariate and multivariate strategies of survival analysis.
Serum anti-alphaGal and APA levels showed wide baseline variability, but remained relatively stable in time. Both were measurable in dialysate of peritoneal dialysis (PD) patients, showing close correlation to serum levels. We observed no association between levels of anti-alphaGal/APA and nutritional markers, but showed direct correlations of anti-alphaGal IgM (P = 0.005) and APA levels (P = 0.001) with tumor necrosis factor alpha (TNF-alpha) levels. High APA levels also were associated with severe anemia (P = 0.006). High baseline anti-alphaGal IgM (P = 0.03) and APA levels (P = 0.045) predicted later risk for enteric peritonitis in PD patients. Finally, univariate and multivariate analyses showed a consistent association between high baseline anti-alphaGal IgM (P = 0.014) and APA (P = 0.021) levels and global risk for mortality during follow-up.
Anti-alphaGal IgM and APA levels at the start of dialysis therapy are significant predictors of later risk for mortality and, in PD patients, enteric peritonitis. Both correlate directly with TNF-alpha levels and, in the case of APA, severity of anemia in these patients.
抗半乳糖α1-3半乳糖抗体（抗αGal）是天然抗体的重要组成部分，与多种疾病状态有关，但其起源和生理意义在很大程度上仍不明确。
在一项前瞻性观察设计中，我们估计了133例开始透析治疗的患者以及1年随访后的抗αGal免疫球蛋白G（IgG）/IgM和抗猪溶血抗体（APA）水平。我们使用基线数据来显示与人口统计学、营养、炎症和贫血标志物的相关性，并通过单变量和多变量生存分析策略分析它们与结局的相关性。
血清抗αGal和APA水平在基线时显示出很大的变异性，但随时间保持相对稳定。两者在腹膜透析（PD）患者的透析液中均可检测到，与血清水平密切相关。我们未观察到抗αGal/APA水平与营养标志物之间的关联，但显示抗αGal IgM（P = 0.005）和APA水平（P = 0.001）与肿瘤坏死因子α（TNF-α）水平直接相关。高APA水平也与严重贫血相关（P = 0.006）。高基线抗αGal IgM（P = 0.03）和APA水平（P = 0.045）预测了PD患者发生肠源性腹膜炎的后期风险。最后，单变量和多变量分析显示，高基线抗αGal IgM（P = 0.014）和APA（P = 0.021）水平与随访期间的总体死亡风险之间存在一致的关联。
透析治疗开始时的抗αGal IgM和APA水平是后期死亡风险以及PD患者肠源性腹膜炎风险的重要预测指标。两者均与TNF-α水平直接相关，就APA而言，还与这些患者的贫血严重程度相关。
