Szeto Cheuk-Chun, Kwan Bonnie Ching-Ha, Chow Kai-Ming, Lai Ka-Bik, Chung Kwok-Yi, Leung Chi-Bon, Li Philip Kam-Tao
Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territory, Hong Kong, China.
Clin J Am Soc Nephrol. 2008 Mar;3(2):431-6. doi: 10.2215/CJN.03600807. Epub 2008 Feb 6.
Systemic inflammatory state is a hallmark of peritoneal dialysis (PD) patients, but its etiology remains obscure. Because circulating microbial products are an important cause of systemic immune activation in other conditions such as HIV infection, it was hypothesized that endotoxemia is a cause of systemic inflammatory state and atherosclerosis in PD patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Plasma lipopolysaccharide (LPS) levels in 30 consecutive new PD patients were measured. The result was compared with serum C-reactive protein (CRP) level, peritoneal transport status, history of pre-existing cardiovascular diseases, and carotid intima media thickness (IMT) by Doppler ultrasound.
Among the 30 PD patients, there were 17 men. The average age was 53.7 +/- 15.1 yr. The average endotoxin concentration of PD patients was 0.44 +/- 0.18 EU/ml, which was significantly higher than that of patients with chronic kidney disease secondary to Ig-A nephropathy (IgAN) (0.035 +/- 0.009 EU/ml, P < 0.0001) and the controls (0.013 +/- 0.007 EU/ml, P < 0.0001). In PD patients, plasma LPS concentration had a significant correlation with serum CRP (r = 0.415, P = 0.025) and serum albumin level (r = -0.394, P = 0.034). In contrast, plasma LPS level did not correlate with Charlson's Comorbidity Index, peritoneal transport characteristics, or nutritional indices. Patients with pre-existing cardiovascular disease (CVD) had higher plasma LPS level than those without CVD (0.53 +/- 0.19 versus 0.36 +/- 0.16 EU/ml, P = 0.016). Plasma LPS level correlated with carotid IMT (r = 0.438, P = 0.016).
It was found that endotoxemia was probably common in PD patients, and the degree of circulating endotoxemia might be related to the severity of systemic inflammation and features of atherosclerosis. This result suggests that endotoxemia may have a contributory role to the systemic inflammatory state and accelerated atherosclerosis in PD patients.
全身炎症状态是腹膜透析（PD）患者的一个标志，但其病因仍不清楚。由于循环中的微生物产物是HIV感染等其他情况下全身免疫激活的重要原因，因此推测内毒素血症是PD患者全身炎症状态和动脉粥样硬化的一个原因。
设计、地点、参与者及测量方法：对30例连续的新发PD患者的血浆脂多糖（LPS）水平进行了测量。将结果与血清C反应蛋白（CRP）水平、腹膜转运状态、既往心血管疾病史以及通过多普勒超声测量的颈动脉内膜中层厚度（IMT）进行比较。
在30例PD患者中，男性17例。平均年龄为53.7±15.1岁。PD患者的平均内毒素浓度为0.44±0.18 EU/ml，显著高于继发于IgA肾病（IgAN）的慢性肾脏病患者（0.035±0.009 EU/ml，P<0.0001）和对照组（0.013±0.007 EU/ml，P<0.0001）。在PD患者中，血浆LPS浓度与血清CRP（r = 0.415，P = 0.025）和血清白蛋白水平（r = -0.394，P = 0.034）显著相关。相比之下，血浆LPS水平与Charlson合并症指数、腹膜转运特征或营养指标无关。有既往心血管疾病（CVD）的患者血浆LPS水平高于无CVD的患者（0.53±0.19对0.36±0.16 EU/ml，P = 0.016）。血浆LPS水平与颈动脉IMT相关（r = 0.438，P = 0.016）。
发现内毒素血症在PD患者中可能很常见，循环内毒素血症的程度可能与全身炎症的严重程度和动脉粥样硬化的特征有关。这一结果表明内毒素血症可能在PD患者的全身炎症状态和加速动脉粥样硬化中起作用。
