慢性肾脏病患者血清可溶性Fas及促红细胞生成素水平

Serum-soluble Fas and serum levels of erythropoietin in chronic kidney disease.

作者信息

Góes M A, Dalboni M A, Manfredi S R, Cendoroglo M S, Batista M C, Canziani M E, Balakrishnan V S, Pereira B J G, Draibe S A, Cendoroglo M

机构信息

Federal University of São Paulo, UNIFESP, São Paulo, Brazil.

出版信息

Clin Nephrol. 2010 Jan;73(1):7-13. doi: 10.5414/cnp73007.

DOI:10.5414/cnp73007

PMID:20040346

Abstract

BACKGROUND

Soluble Fas levels (sFas) are increased in the serum of uremic patients and are associated with the presence of anemia and recombinant human EPO (rHuEPO) dosage in dialysis patients. It is possible that sFas levels are associated with an increased need for serum erythropoietin levels (Epo) in chronic kidney disease and dialysis patients in order to maintain hematocrit (Hct) levels.

AIMS

To investigate the relationship between serum sFas levels, serum Epo levels and the ratio between Epo levels and Hct in uremic patients.

METHODS

We studied 52 predialysis chronic kidney disease patients (CKD; 33 M, 57 +/- 12 years, hematocrit (Hct) = 37 +/- 7%), 29 peritoneal dialysis patients (PD; 12 M, 54 +/- 14 years, Hct = 36 +/- 7%), 29 hemodialysis patients (HD; 19 M, 47 +/- 14 years, Hct = 33 +/- 5%) and 29 healthy volunteers (control group 17 M, 50 +/- 16 years, Hct = 43 +/- 3%). We examined the relationship between Hct and serum levels of Epo, sFas, C-reactive protein, IL-6 and iron status. The ratio of serum Epo divided by Hct (Epo/Hct) was used as an indicator of Epo responsiveness.

RESULTS

Compared to normal subjects, the CKD, PD and HD groups presented lower Hct levels and higher serum levels of sFas, Epo, Epo/Hct and IL-6. Serum levels of sFas correlated negatively with albumin (r = -0.24, p = 0.02), IL-6 (r = -0.18, p = 0.04) and Epo/Hct (r = -0.37, p < 0.001). In multivariate analysis, after adjusting for markers of iron store and inflammation, only sFas correlated with Epo/Hct. In the CKD group, there were negative correlations between serum levels of sFas and glomerular filtration rate (GFR) (r = -0.45, p < 0.001) and between Epo/Hct and GFR (r = -0.32; p = 0.02). There was a positive correlation between Epo/Hct and serum levels of sFas in the CKD group (r = 0.31, p = 0.03) and in the HD groups (r = 0.58, p = 0.001).

CONCLUSION

Our findings show that serum sFas is associated with higher Epo/Hct ratio, suggesting that sFas may be a marker of Epo hyporesponsiveness in uremia. Further studies are needed to determine whether sFas is just a marker of Epo hyporesponsiveness or is also involved in its pathophysiology.

摘要

背景

尿毒症患者血清中可溶性Fas水平（sFas）升高，且与透析患者贫血的存在及重组人促红细胞生成素（rHuEPO）剂量相关。在慢性肾脏病和透析患者中，sFas水平可能与维持血细胞比容（Hct）水平所需的血清促红细胞生成素水平（Epo）增加有关。

目的

研究尿毒症患者血清sFas水平、血清Epo水平以及Epo水平与Hct之间的比值关系。

方法

我们研究了52例透析前慢性肾脏病患者（CKD；男性33例，年龄57±12岁，血细胞比容（Hct）=37±7%）、29例腹膜透析患者（PD；男性12例，年龄54±14岁，Hct=36±7%）、29例血液透析患者（HD；男性19例，年龄47±14岁，Hct=33±5%）和29例健康志愿者（对照组；男性17例，年龄50±16岁，Hct=43±3%）。我们检测了Hct与血清Epo、sFas、C反应蛋白、IL-6水平及铁状态之间的关系。血清Epo除以Hct的比值（Epo/Hct）用作Epo反应性的指标。

结果

与正常受试者相比，CKD、PD和HD组的Hct水平较低，血清sFas、Epo、Epo/Hct和IL-6水平较高。血清sFas水平与白蛋白（r=-0.24，p=0.02）、IL-6（r=-0.18，p=0.04）和Epo/Hct（r=-0.37，p<0.001）呈负相关。在多变量分析中，校正铁储备和炎症标志物后，只有sFas与Epo/Hct相关。在CKD组中，血清sFas水平与肾小球滤过率（GFR）呈负相关（r=-0.45，p<0.001），Epo/Hct与GFR也呈负相关（r=-0.32；p=0.02）。CKD组（r=0.31，p=0.03）和HD组（r=0.58，p=0.001）中，Epo/Hct与血清sFas水平呈正相关。