An W S, Son Y K, Kim S E, Kim K H, Bae H R, Lee S, Park Y, Kim H J, Vaziri N D
Department of Internal Medicine, Dong-A University, 3Ga-1, Dongdaesin-Dong, Seo-Gu, Busan 602-715, Republic of Korea.
Clin Nephrol. 2011 Mar;75(3):195-203. doi: 10.5414/cnp75195.
Besides regulating energy metabolism, leptin promotes and adiponectin suppresses inflammation which is a common feature of end-stage renal disease (ESRD). Omega-3 fatty acids (n-3FA) exert anti-inflammatory actions by inhibiting pro-inflammatory signal transduction pathways whereas arachidonic acid (an n-6FA) facilitates inflammation by mediating inflammatory signals and serving as precursor of pro-inflammatory eicosanoids. Given the functional overlap between adipokines and n-3FA and n-6FA, we sought to explore their interrelationship in patients with ESRD.
44 ESRD patients maintained on hemodialysis (HD), 29 patients receiving peritoneal dialysis (PD), and 10 healthy subjects were enrolled. Body mass index (BMI), plasma leptin, adiponectin, lipids and CRP and erythrocyte fatty acids were measured.
Compared to controls adiponectin was elevated and leptin level was reduced in the ESRD group. Adiponectin levels were comparable among PD and HD patients, but leptin and BMI were higher in PD than in HD patients. Despite comparable BMIs, female patients had higher leptin than male patients. Leptin levels were positively associations with BMI, total and LDL cholesterol whereas adiponectin was inversely related with BMI, triglycerides and CRP and directly associated with HDL cholesterol in ESRD patients. Plasma adiponectin was directly associated with erythrocyte n-3 FA (r = 0.581, p = 0.023) and inversely associated with n-6FA (r = -0.640, p = 0.010) in the HD patients.
A direct association was found between plasma levels of adiponectin and HDL and erythrocyte n-3FA in ESRD patients. Prospective trials are needed to explore the effect of n-3FA supplementation on plasma adipokines and markers of oxidative stress and inflammation in this population.
除了调节能量代谢外，瘦素可促进炎症，而脂联素可抑制炎症，炎症是终末期肾病（ESRD）的一个常见特征。ω-3脂肪酸（n-3FA）通过抑制促炎信号转导途径发挥抗炎作用，而花生四烯酸（一种n-6FA）通过介导炎症信号并作为促炎类二十烷酸的前体促进炎症。鉴于脂肪因子与n-3FA和n-6FA之间存在功能重叠，我们试图探讨它们在ESRD患者中的相互关系。
纳入44例维持性血液透析（HD）的ESRD患者、29例接受腹膜透析（PD）的患者和10名健康受试者。测量体重指数（BMI）、血浆瘦素、脂联素、血脂、CRP以及红细胞脂肪酸。
与对照组相比，ESRD组脂联素升高，瘦素水平降低。PD患者和HD患者的脂联素水平相当，但PD患者的瘦素和BMI高于HD患者。尽管BMI相当，但女性患者的瘦素高于男性患者。在ESRD患者中，瘦素水平与BMI、总胆固醇和低密度脂蛋白胆固醇呈正相关，而脂联素与BMI、甘油三酯和CRP呈负相关，与高密度脂蛋白胆固醇呈正相关。HD患者血浆脂联素与红细胞n-3FA呈正相关（r = 0.581，p = 0.023），与n-6FA呈负相关（r = -0.640，p = 0.010）。
在ESRD患者中，发现血浆脂联素水平与高密度脂蛋白以及红细胞n-3FA之间存在直接关联。需要进行前瞻性试验来探讨补充n-3FA对该人群血浆脂肪因子以及氧化应激和炎症标志物的影响。
