Department of Pediatric Nephrology, Medical University, Wroclaw, Poland.
Perit Dial Int. 2010 Mar-Apr;30(2):227-32. doi: 10.3747/pdi.2008.00153. Epub 2010 Jan 15.
Chronic kidney disease (CKD) due to inflammation, lipid disorders, and endothelial dysfunction predisposes to accelerated atherosclerosis. Elevated levels of heat shock proteins (HSPs) and antibodies against them have been described in adults with atherosclerotic lesions and cardiovascular events. However, there are no investigations of these variables in children with CKD treated conservatively or on peritoneal dialysis. Therefore, we decided to evaluate the profile of HSPs and their potential role as markers of atherosclerosis in these groups of patients.
The study group consisted of 37 children with CKD treated conservatively and 19 children and young adults on automated peritoneal dialysis (APD). The control group comprised 15 age-matched subjects with normal kidney function. HSP-60, HSP-70, HSP-90alpha, anti-HSP-60, anti-HSP-70, sE-selectin, and interleukin (IL)-4 serum concentrations were assessed by ELISA; high-sensitivity C-reactive protein (hs-CRP) serum levels were assessed by nephelometry. Serum lipid profiles (total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglycerides) were also estimated.
HSP-90alpha, anti-HSP-60, and sE-selectin concentrations in the CKD and APD patients were higher than in the controls and were lower in the predialysis subjects than in the children on dialysis. Median values of anti-HSP-70 were higher in the CKD patients than in the control group. Levels of IL-4 were increased in all patients versus controls. Median values of HSP-60 were decreased in the CKD and APD children versus controls. HSP-70 and hs-CRP concentrations were comparable in all groups.
The altered HSP and anti-HSP concentrations may imply that the response to stress conditions in the course of CKD is disturbed in children; APD does not aggravate that dysfunction in a significant way. Relationships between HSPs, lipid profile, and markers of inflammation suggest a possible role of the selected HSPs as markers of atherosclerosis in children with CKD.
由炎症、脂质紊乱和内皮功能障碍引起的慢性肾脏病（CKD）易导致动脉粥样硬化加速。在有动脉粥样硬化病变和心血管事件的成年人中，已经描述了热休克蛋白（HSPs）及其抗体的水平升高。然而，在接受保守治疗或腹膜透析的儿童中，尚未对这些变量进行研究。因此，我们决定评估 HSPs 谱及其在这些患者群体中作为动脉粥样硬化标志物的潜在作用。
研究组包括 37 名接受保守治疗的 CKD 儿童和 19 名接受自动腹膜透析（APD）的儿童和年轻成人。对照组包括 15 名年龄匹配的肾功能正常的受试者。通过 ELISA 评估 HSP-60、HSP-70、HSP-90alpha、抗-HSP-60、抗-HSP-70、sE-选择素和白细胞介素（IL）-4 血清浓度；通过比浊法评估高敏 C 反应蛋白（hs-CRP）血清水平。还估计了血清脂质谱（总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯）。
CKD 和 APD 患者的 HSP-90alpha、抗-HSP-60 和 sE-选择素浓度高于对照组，而透析前患者的浓度低于透析儿童。与对照组相比，CKD 患者的抗-HSP-70 中位数较高。与对照组相比，所有患者的 IL-4 水平均升高。CKD 和 APD 儿童的 HSP-60 中位数值低于对照组。HSP-70 和 hs-CRP 浓度在所有组中均相似。
改变的 HSP 和抗 HSP 浓度可能意味着在 CKD 过程中，儿童对应激条件的反应受到干扰；APD 不会以显著方式加重这种功能障碍。HSPs、脂质谱和炎症标志物之间的关系表明，所选 HSPs 可能在 CKD 儿童中作为动脉粥样硬化的标志物发挥作用。
