血清脂联素与慢性肾脏病和肾移植中的心血管风险。

Serum adiponectin and cardiovascular risk in chronic kidney disease and kidney transplantation.

机构信息

Renal and Transplantation Unit, St. George's Hospital NHS Trust, London, UK.

出版信息

J Nephrol. 2010 Jan-Feb;23(1):77-84.

PMID:20091490

Abstract

BACKGROUND

Serum adiponectin is inversely linked to obesity, impaired glucose homeostasis, dyslipidemia and hypertension and has been suggested as a possible marker of cardiovascular (CV) disease in the general population. However, its role in chronic kidney disease and following renal transplantation is not well established.

METHODS

This study examined the relationship of adiponectin with CV risk factors and kidney function in patients with predialysis chronic kidney disease (CKD) (n=33) and those who had undergone a renal transplantation (n=43). Serum adiponectin was measured using ELISA. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) study formula. Associations of adiponectin with clinical and laboratory parameters were tested.

RESULTS

Mean age of the population was 37 +/- 11 years, 83% were men, 18% had diabetes and mean GFR was 48 +/- 29 ml/min per 1.73 m2. Adiponectin levels inversely related with eGFR (p=0.021), body mass index (BMI) (p=0.024), waist circumference (p=0.018) and hemoglobin (p=0.004), and directly related with high-sensitivity C-reactive protein (hsCRP) (p=0.019). It did not correlate with blood pressure, lipids, fasting glucose or smoking. On multivariate analysis, eGFR (beta=-0.360, p=0.002) and BMI (beta=-0.346, p=0.003) were independent determinants of adiponectin, adjusted for age, sex, lipids, diabetes, hypertension and transplant status. Renal transplant patients had lower CV risk, however adiponectin was similar to CKD patients (22 +/- 17 vs. 23 +/- 21; p=0.8). Adiponectin was inversely related to eGFR (p=0.003).

CONCLUSION

This is the first study showing that serum adiponectin is a poor predictor of cardiovascular risk in both the CKD and renal transplant population. Serum adiponectin levels are influenced by renal function. Adiponectin levels increased with decreasing kidney function in CKD renal transplant recipients. Despite better CV risk profile, transplant patients had similar adiponectin levels to those of CKD patients. We conclude that adiponectin levels do not reflect the high CV risk in CKD.

摘要

背景

血清脂联素与肥胖、葡萄糖稳态受损、血脂异常和高血压呈负相关，并被认为是普通人群心血管疾病的一个可能标志物。然而，其在慢性肾脏病及肾移植后的作用尚未明确。

方法

本研究检测了脂联素与透析前慢性肾脏病（CKD）（n=33）和肾移植患者（n=43）的心血管危险因素和肾功能之间的关系。采用 ELISA 法检测血清脂联素。采用改良肾脏病膳食研究（MDRD）公式计算估计肾小球滤过率（eGFR）。检测脂联素与临床和实验室参数的相关性。

结果

人群平均年龄为 37±11 岁，83%为男性，18%患有糖尿病，平均肾小球滤过率（GFR）为 48±29ml/min/1.73m2。脂联素水平与 eGFR（p=0.021）、体重指数（BMI）（p=0.024）、腰围（p=0.018）和血红蛋白（p=0.004）呈负相关，与高敏 C 反应蛋白（hsCRP）（p=0.019）呈正相关。它与血压、血脂、空腹血糖或吸烟均无相关性。多变量分析显示，eGFR（β=-0.360，p=0.002）和 BMI（β=-0.346，p=0.003）是脂联素的独立决定因素，校正年龄、性别、血脂、糖尿病、高血压和移植状态后。肾移植患者的心血管风险较低，但脂联素与 CKD 患者相似（22±17 vs. 23±21；p=0.8）。脂联素与 eGFR 呈负相关（p=0.003）。