炎症和蛋白能量消耗与腹膜透析患者内皮功能障碍的关系。

Association of inflammation and protein-energy wasting with endothelial dysfunction in peritoneal dialysis patients.

机构信息

Department of Internal Medicine, Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, Korea.

出版信息

Nephrol Dial Transplant. 2010 Apr;25(4):1266-71. doi: 10.1093/ndt/gfp598. Epub 2009 Nov 19.

DOI:10.1093/ndt/gfp598

PMID:19926717

Abstract

BACKGROUND

Cardiovascular disease is the main cause of mortality in end-stage renal disease (ESRD) patients. Recent studies have indicated that non-traditional risk factors such as endothelial dysfunction (ED), chronic inflammation and protein-energy wasting (PEW) may contribute significantly to the increased cardiovascular mortality among dialysis patients. To further ascertain this association, we carried out a cross-sectional assessment of nutritional status, inflammatory markers and endothelial dysfunction in peritoneal dialysis (PD) patients.

METHODS

We measured ED functionally by flow-mediated vasodilatation (FMD) using doppler ultrasonography and biochemically by soluble intercellular adhesion molecule-1 (sICAM-1) in 105 stable PD patients and 32 age- and sex-matched healthy controls. We also simultaneously measured inflammatory markers and performed a subjective global assessment (SGA) of their nutritional status using a seven-point scoring scale. Subjects were subgrouped according to their nutritional and inflammatory status.

RESULTS

In PD patients, FMD was markedly lower (9.9 +/- 4.8% vs. 16.4 +/- 4.8%, P < 0.05), and sICAM-1 was significantly higher than those in controls. The malnourished patients had significantly lower FMD (8.4+/-4.6% vs. 10.8+/-4.7%, P <0.05) and higher sICAM-1 than the nourished patients. The inflamed group had significantly lower FMD (7.1 +/- 3.8 vs.11.1 +/- 4.6%, P < 0.05) and higher sICAM-1 than the non-inflamed group. In all PD patients, lean body mass/body weight %, albumin and SGA correlated positively with FMD (r = +0.207, r = +0.224, r = +0.285, P < 0.05). However, age, log high sensitivity C-reactive protein (hsCRP), log IL-6 and sICAM-1 were negatively correlated with FMD (r = -0.275, r = -0.361, r = -0.360, r = -0.271, P < 0.05). A multiple regression analysis showed that log hsCRP was an independent factor affecting FMD. Endothelial function, demonstrated as FMD and sICAM-1 in the nourished PD patients without inflammation, was well preserved compared to other subgroups.

CONCLUSION

Our data suggest that chronic inflammation and PEW are closely linked to ED in PD patients.

摘要

背景

心血管疾病是终末期肾病（ESRD）患者死亡的主要原因。最近的研究表明，内皮功能障碍（ED）、慢性炎症和蛋白质能量消耗（PEW）等非传统危险因素可能是导致透析患者心血管死亡率升高的重要原因。为了进一步确定这种相关性，我们对腹膜透析（PD）患者的营养状况、炎症标志物和内皮功能进行了横断面评估。

方法

我们使用多普勒超声测量 105 例稳定 PD 患者和 32 名年龄和性别匹配的健康对照者的 ED 功能（FMD），并用可溶性细胞间黏附分子-1（sICAM-1）进行生化测量。同时，我们还测量了炎症标志物，并使用七点评分量表对其营养状况进行了主观全面评估（SGA）。根据患者的营养和炎症状况对其进行了分组。

结果

PD 患者的 FMD 明显降低（9.9+/-4.8%比 16.4+/-4.8%，P<0.05），sICAM-1 显著高于对照组。营养不良患者的 FMD 明显降低（8.4+/-4.6%比 10.8+/-4.7%，P<0.05），sICAM-1 也高于营养良好的患者。炎症组的 FMD 明显降低（7.1 +/- 3.8 比 11.1 +/- 4.6%，P < 0.05），sICAM-1 也高于非炎症组。在所有 PD 患者中，瘦体重/体重%、白蛋白和 SGA 与 FMD 呈正相关（r = +0.207，r = +0.224，r = +0.285，P<0.05）。然而，年龄、高敏 C 反应蛋白（hsCRP）、白细胞介素-6（IL-6）和 sICAM-1 与 FMD 呈负相关（r = -0.275，r = -0.361，r = -0.360，r = -0.271，P<0.05）。多元回归分析显示，hsCRP 是影响 FMD 的独立因素。在无炎症的营养良好的 PD 患者中，内皮功能（表现为 FMD 和 sICAM-1）保持良好，与其他亚组相比。