Amira Oluwatoyin C, Naicker Saraladevi, Manga Pravin, Sliwa Karen, Mia Alamgir, Raal Frederick, Crowther Nigel John, Immelman Ronald A, Olorunju Steve
Division of Nephrology, University of Witwatersrand, J ohannesburg, South Africa.
Hemodial Int. 2012 Jan;16(1):59-68. doi: 10.1111/j.1542-4758.2011.00622.x.
Atherosclerotic cardiovascular disease (CVD) is the major cause of morbidity and mortality in hemodialysis (HD) patients. Adiponectin (ADPN), a recently discovered collagen-like protein, is secreted exclusively by adipocytes. It has anti-atherogenic properties and reduced serum ADPN levels have been shown to be predictive of cardiovascular events. In this study, we determined the atherosclerotic risk and the significance of ADPN levels in our HD patients and also examined its relationship to other traditional CVD risk factors. A cross-sectional study of 84 patients on maintenance HD (58 Blacks and 26 non-Blacks) and 63 healthy controls matched for age, sex and race (35 Blacks and 28 non-Blacks) was undertaken. Serum ADPN levels and other risk factors, including blood pressure, serum lipid, and C-reactive protein, were studied in HD patients and were compared with the controls. Carotid artery intima-media thickness and plaque occurrence was measured by B-mode ultrasonography while echocardiography was done according to American Society of Echocardiography guidelines. Serum ADPN levels were higher in the HD group compared with the control subjects (22.19 ± 0.98 mg/mL vs. 9.93 ± 0.68 mg/mL; P < 0.001). Higher ADPN levels in HD patients were associated with lower triglyceride levels. ADPN correlated positively (r = 0.49, P < 0.0001) with left ventricular mass index (LVMI) in the total study population. ADPN levels were raised in HD patients and correlated with LVMI, possibly because of the confounding effect of low glomerular filtration rate. ADPN levels were inversely related to risk factors for atherosclerosis and may provide possible targets for therapeutic interventions.
动脉粥样硬化性心血管疾病（CVD）是血液透析（HD）患者发病和死亡的主要原因。脂联素（ADPN）是一种最近发现的类胶原蛋白，仅由脂肪细胞分泌。它具有抗动脉粥样硬化特性，血清ADPN水平降低已被证明可预测心血管事件。在本研究中，我们确定了HD患者的动脉粥样硬化风险及ADPN水平的意义，并研究了其与其他传统CVD危险因素的关系。对84例维持性HD患者（58例黑人、26例非黑人）和63例年龄、性别和种族相匹配的健康对照者（35例黑人、28例非黑人）进行了横断面研究。研究了HD患者的血清ADPN水平及其他危险因素，包括血压、血脂和C反应蛋白，并与对照组进行比较。采用B型超声测量颈动脉内膜中层厚度和斑块发生率，同时根据美国超声心动图学会指南进行超声心动图检查。HD组血清ADPN水平高于对照组（22.19±0.98mg/mL对9.93±0.68mg/mL；P<0.001）。HD患者较高的ADPN水平与较低的甘油三酯水平相关。在整个研究人群中，ADPN与左心室质量指数（LVMI）呈正相关（r=0.49，P<0.0001）。HD患者的ADPN水平升高并与LVMI相关，可能是由于低肾小球滤过率的混杂效应。ADPN水平与动脉粥样硬化危险因素呈负相关，可能为治疗干预提供潜在靶点。
