Weiner D E, Tighiouart H, Elsayed E F, Griffith J L, Salem D N, Levey A S, Sarnak M J
Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts 02111, USA.
Kidney Int. 2008 Jun;73(12):1406-12. doi: 10.1038/ki.2008.75. Epub 2008 Apr 9.
Inflammation and chronic kidney disease predict cardiovascular events. Here we evaluated markers of inflammation including fibrinogen, albumin and white blood cell count in individuals with and without stages 3-4 chronic kidney disease to assess inflammation as a risk factor for adverse events, the synergy between inflammation and chronic kidney disease, and the prognostic ability of these inflammatory markers relative to that of C-reactive protein. Using Atherosclerosis Risk in Communities and Cardiovascular Health Study data, inflammation was defined by worst quartile of at least 2 of these 3 markers. In Cox regression models, inflammation was assessed as a risk factor for a composite of cardiac events, stroke and mortality as well as components of this composite. Among 20 413 patients, inflammation was identified in 3594 and chronic kidney disease in 1649. In multivariable analyses, both inflammation and chronic kidney disease predicted all outcomes, but their interaction was non-significant. In 5597 patients with C-reactive protein levels, inflammation and elevated C-reactive protein had similar hazard ratios. When focusing only on individuals with the worst quartile of white cell count and albumin, results remained consistent.
炎症和慢性肾脏病可预测心血管事件。在此，我们评估了炎症标志物，包括纤维蛋白原、白蛋白和白细胞计数，这些评估对象为患有和未患有3-4期慢性肾脏病的个体，以评估炎症作为不良事件风险因素的情况、炎症与慢性肾脏病之间的协同作用，以及这些炎症标志物相对于C反应蛋白的预后能力。利用社区动脉粥样硬化风险研究和心血管健康研究的数据，炎症由这三种标志物中至少两种处于最差四分位数来定义。在Cox回归模型中，炎症被评估为心脏事件、中风和死亡综合结局以及该综合结局各组成部分的风险因素。在20413例患者中，3594例被确定存在炎症，1649例存在慢性肾脏病。在多变量分析中，炎症和慢性肾脏病均能预测所有结局，但它们之间的相互作用无统计学意义。在5597例有C反应蛋白水平数据的患者中，炎症和C反应蛋白升高具有相似的风险比。仅关注白细胞计数和白蛋白处于最差四分位数的个体时，结果仍然一致。
