Young Pablo, Lombi Fernando, Finn Barbara C, Forrester Mariano, Campolo-Girard Vicente, Pomeranz Vanesa, Iriarte Romina, Bruetman Julio E, Trimarchi Hernan
Servicio de Clínica Médica, Hospital Británico de Buenos Aires.
Medicina (B Aires). 2011;71(1):66-72.
Protein-energy wasting (PEW) and inflammation are usually common and concurrent conditions in maintenance dialysis patients and associated with poor prognosis. Low appetite and hypercatabolic states are common features. In dialysis patients, the former has been suggested to be secondary to inflammation; however, the evidence is not conclusive. Hence, the term malnutrition-inflammation complex syndrome (MICS) was coined to include this clinical entity, regardless the original causes. Possible causes of MICS include comorbid illnesses, oxidative stress, nutrient loss through dialysis, hyporexia, uremic toxins, decreased clearance of inflammatory cytokines, volume overload, increased blood phosphate and dialysis-related factors. MICS is believed to be the main cause of erythropoietin hypo-responsiveness, cardiovascular atherosclerotic disease, decreased quality of life, hospitalization and increased mortality in dialysis patients. Because MICS leads to a low body mass index, hypocholesterolemia, decrease in muscle mass, hypocreatininemia and hypohomocysteinemia, a "reverse epidemiology" phenomenon of cardiovascular risk factors can occur in dialysis patients. Therefore, obesity, hypercholesterolemia, and increased blood levels of creatinine and homocysteine, within certain limits, appear to be protective and paradoxically associated with a better outcome. There is no consensus about how to determine the degree of severity of MICS or how to manage it. Several diagnostic tools and treatment modalities are discussed in this paper. The correct management of MICS may diminish the cardiovascular disease, main cause of death in this population.
蛋白质能量消耗（PEW）和炎症在维持性透析患者中通常很常见且同时存在，并与不良预后相关。食欲减退和高分解代谢状态是常见特征。在透析患者中，前者被认为是炎症的继发表现；然而，证据并不确凿。因此，提出了营养不良-炎症复合综合征（MICS）这一术语来涵盖这一临床实体，而不考虑其原始病因。MICS的可能病因包括合并症、氧化应激、透析导致的营养物质流失、食欲减退、尿毒症毒素、炎症细胞因子清除减少、容量超负荷、血磷升高和透析相关因素。MICS被认为是透析患者促红细胞生成素低反应性、心血管动脉粥样硬化疾病、生活质量下降、住院率和死亡率增加的主要原因。由于MICS导致体重指数降低、低胆固醇血症、肌肉量减少、血肌酐降低和血同型半胱氨酸降低，透析患者可能会出现心血管危险因素的“逆流行病学”现象。因此，在一定范围内，肥胖、高胆固醇血症以及血肌酐和同型半胱氨酸水平升高似乎具有保护作用，并且反常地与更好的预后相关。关于如何确定MICS的严重程度或如何对其进行管理尚无共识。本文讨论了几种诊断工具和治疗方法。正确管理MICS可能会减少该人群主要死因心血管疾病的发生。
