非糖尿病腹膜透析尿毒症患者血浆脂联素与心血管风险谱的相关性

Association of plasma adiponectin and cardiovascular risk profiles in nondiabetic uremic patients on peritoneal dialysis.

作者信息

Tsao Yu-Tzu, Hsu Yu-Juei, Chu Nien-Feng, Lai Ching-Huang, Chiu Jiann-Shiun, Lin Shih-Hua

机构信息

Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan - ROC.

出版信息

J Nephrol. 2008 Sep-Oct;21(5):744-52.

PMID:18949730

Abstract

BACKGROUND

Adiponectin, a novel adipocytokine with antiinflammatory and antiatherosclerosis properties, has been found to be an inverse predictor of cardiovascular outcomes among uremic patients on hemodialysis. However, its role in uremic patients on continuous ambulatory peritoneal dialysis (CAPD) remains unclear. The aim of the study was to evaluate the association of adiponectin and cardiovascular risk factors in nondiabetic CAPD patients.

METHODS

Sixty nondiabetic uremic patients on CAPD for more than 6 months were enrolled. Plasma adiponectin levels were measured along with cardiovascular risk profiles, including body mass index (BMI), waist to hip ratio (WHR), insulin resistance, lipid profiles, ankle-brachial pressure index (ABPI), brachial-ankle pulse wave velocity (BaPWV), inflammatory markers and peritoneal membrane characteristics. Dialysis adequacy, protein intake, residual renal function and serum biochemistries were also studied.

RESULTS

Plasma adiponectin levels were significantly higher in CAPD patients than healthy subjects (16.0 +/- 11.8 vs. 6.4 +/- 1.8 microg/mL, p<0.001); inversely related to BMI, WHR, triglyceride levels, atherogenic index, insulin levels, homeostasis model assessment of insulin resistance and C-reactive protein (CRP), and directly related to high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). There was also a positive trend between plasma adiponectin levels and the ratios of dialysate to plasma creatinine concentration (D/P Cr). On multivariate regression analysis, BMI and HDL-C were the strongest variables associated with plasma adiponectin levels.

CONCLUSIONS

Hyperadiponectinemia in nondiabetic uremic patients on CAPD is in part associated with cardiovascular risk factors. Whether elevated adiponectin concentrations exert cardioprotective and antiinflammation effects in uremic patients on CAPD warrants further prospective investigation.

摘要

背景

脂联素是一种具有抗炎和抗动脉粥样硬化特性的新型脂肪细胞因子，已被发现是血液透析的尿毒症患者心血管结局的反向预测指标。然而，其在持续非卧床腹膜透析（CAPD）的尿毒症患者中的作用仍不清楚。本研究的目的是评估非糖尿病CAPD患者中脂联素与心血管危险因素之间的关联。

方法

纳入60例接受CAPD超过6个月的非糖尿病尿毒症患者。测量血浆脂联素水平以及心血管风险指标，包括体重指数（BMI）、腰臀比（WHR）、胰岛素抵抗、血脂谱、踝臂压力指数（ABPI）、臂踝脉搏波速度（BaPWV）、炎症标志物和腹膜特性。还研究了透析充分性、蛋白质摄入量、残余肾功能和血清生化指标。

结果

CAPD患者的血浆脂联素水平显著高于健康受试者（16.0±11.8 vs. 6.4±1.8 μg/mL，p<0.001）；与BMI、WHR、甘油三酯水平、致动脉粥样硬化指数、胰岛素水平、胰岛素抵抗稳态模型评估和C反应蛋白（CRP）呈负相关，与高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）呈正相关。血浆脂联素水平与透析液肌酐浓度与血浆肌酐浓度之比（D/P Cr）之间也存在正相关趋势。多变量回归分析显示，BMI和HDL-C是与血浆脂联素水平相关的最强变量。