Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, MLC: 7022, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
Pediatr Nephrol. 2011 Nov;26(11):2009-17. doi: 10.1007/s00467-011-1906-x. Epub 2011 May 8.
In contrast to the general population, patients with chronic kidney disease (CKD) experience increased total adiponectin levels despite an increased prevalence of cardiovascular disease. Adiponectin circulates as trimer, low molecular weight (LMW), and high molecular weight (HMW) complexes. The distribution and role of each subfraction in CKD is unknown. This cross-sectional analysis examined the association of serum adiponectin and its subfractions with known cardiovascular risk factors in 105 children (median age 12 years; 56% male) enrolled into the Chronic Kidney Disease in Children (CKiD) study, an observational cohort study of children with CKD stage 2-4.HMW accounted for 46% of total adiponectin, followed by LMW (34%) and trimer (20%). In multivariable analysis, LMW was independently associated with iohexol glomerular filtration rate (GFR) (p = 0.004) and was higher in pubertal versus prepubertal children (p = 0.005). HMW/LMW ratio was independently associated with age and iohexol GFR (all p < 0.001). Unexpectedly, systolic blood pressure was positively correlated with HMW (p = 0.01), and HMW/LMW ratio (p = 0.007) and inversely correlated with LMW (p = 0.009). Among subfractions, only LMW was significantly correlated with left ventricular mass (LVM) index (p = 0.05). In multivariable analysis, decreased LMW was independently associated with higher LVM index [β= -0.25, 95% confidence interval (CI) -0.50, -0.03, p=0.04) after adjustment for body mass index (BMI), age, and blood pressure.The higher total adiponectin levels in children with CKD are associated with higher HMW and lower LMW. This imbalance may be an important biomarker for increased cardiovascular risk despite higher levels of total adiponectin in children with CKD.
与普通人群相比，尽管慢性肾脏病（CKD）患者的心血管疾病患病率增加，但他们的总脂联素水平升高。脂联素以三聚体、低分子量（LMW）和高分子量（HMW）复合物的形式循环。每种亚组分在 CKD 中的分布和作用尚不清楚。本横断面分析检查了 105 名儿童（中位数年龄 12 岁；56%为男性）的血清脂联素及其亚组分与已知心血管危险因素的相关性，这些儿童入组了慢性肾脏病儿童（CKiD）研究，这是一项针对 CKD 2-4 期儿童的观察队列研究。HMW 占总脂联素的 46%，其次是 LMW（34%）和三聚体（20%）。在多变量分析中，LMW 与 iohexol 肾小球滤过率（GFR）独立相关（p=0.004），且在青春期与青春期前儿童中更高（p=0.005）。HMW/LMW 比值与年龄和 iohexol GFR 独立相关（均 p<0.001）。出乎意料的是，收缩压与 HMW 呈正相关（p=0.01），与 HMW/LMW 比值呈正相关（p=0.007），与 LMW 呈负相关（p=0.009）。在亚组分中，只有 LMW 与左心室质量（LVM）指数显著相关（p=0.05）。在多变量分析中，调整体重指数（BMI）、年龄和血压后，LMW 降低与更高的 LVM 指数独立相关[β=-0.25，95%置信区间（CI）-0.50，-0.03，p=0.04]。CKD 儿童中较高的总脂联素水平与较高的 HMW 和较低的 LMW 相关。尽管 CKD 儿童的总脂联素水平较高，但这种不平衡可能是心血管风险增加的一个重要生物标志物。
