Ohashi Naro, Kato Akihiko, Misaki Taro, Sakakima Masanori, Fujigaki Yoshihide, Yamamoto Tatsuo, Hishida Akira
The First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu.
Intern Med. 2008;47(6):485-91. doi: 10.2169/internalmedicine.47.0614. Epub 2008 Mar 17.
Adiponectin (ADPN) has been shown to protect against cardiovascular disease for the general population with problematic metabolic syndrome. However, it remains unclear whether ADPN is associated with mortality in patients on maintenance hemodialysis (HD). METHODS, PATIENTS OR MATERIALS: We selected 85 HD patients [51 men/34 women; mean age, 64+/-2 years; underlying kidney diseases, diabetic nephropathy in 36 patients (42.3%), chronic glomerulonephritis in 29 (34.1%), hypertensive nephrosclerosis in 10 (11.8%), and others in 10 (11.8%)] who survived for more than 3 months after the start of HD. We first measured serum ADPN levels and prospectively followed patients for the next 3 years.
We were able to follow 74 of 85 patients; 59 survived, and 15 died. Serum log-transformed ADPN levels were negatively correlated with BMI (r=-0.43, p<0.01). Despite a similar BMI (20.7+/-0.8 vs. 20.3+/-0.4 kg/m(2)), the expired patients had significantly higher ADPN compared with the surviving patients (20.5 microg/ml [14.0-23.5] vs. 14.2 microg/ml [9.7-21.3], p<0.05). Cox-hazards multivariate regression analysis adjusted for conventional case-mix features (age, sex, and underlying kidney disease) revealed that serum ADPN became a significant determinant of all-cause mortality. There was a 10.3% risk increment for each 1-microg/ml increase in ADPN during the follow-up. Kaplan-Meier analysis revealed that patients with higher ADPN levels (> or =15 microg/ml) had a significantly lower survival rate compared with those with lower ADPN levels (<15 microg/ml) (76 vs. 92%, p<0.05).
These results indicated that high rather than low ADPN independently predict total mortality in HD patients.
脂联素（ADPN）已被证明可保护患有代谢综合征问题的普通人群免受心血管疾病的影响。然而，脂联素是否与维持性血液透析（HD）患者的死亡率相关仍不清楚。方法、患者或材料：我们选择了85例HD患者[51名男性/34名女性；平均年龄，64±2岁；基础肾脏疾病，36例（42.3%）为糖尿病肾病，29例（34.1%）为慢性肾小球肾炎，10例（11.8%）为高血压性肾硬化，10例（11.8%）为其他疾病]，这些患者在HD开始后存活超过3个月。我们首先测量血清ADPN水平，并在接下来的3年中对患者进行前瞻性随访。
我们能够对85例患者中的74例进行随访；59例存活，15例死亡。血清经对数转换的ADPN水平与体重指数呈负相关（r = -0.43，p < 0.01）。尽管体重指数相似（20.7±0.8 vs. 20.3±0.4 kg/m²），但死亡患者的ADPN水平显著高于存活患者（20.5微克/毫升[14.0 - 23.5] vs. 14.2微克/毫升[9.7 - 21.3]，p < 0.05）。针对传统病例组合特征（年龄、性别和基础肾脏疾病）进行调整的Cox风险多变量回归分析显示，血清ADPN成为全因死亡率的重要决定因素。随访期间，ADPN每增加1微克/毫升，风险增加10.3%。Kaplan - Meier分析显示，ADPN水平较高（≥15微克/毫升）的患者与ADPN水平较低（<15微克/毫升）的患者相比，生存率显著降低（76%对92%，p < 0.05）。
这些结果表明，ADPN水平高而非低可独立预测HD患者的总死亡率。
