Garcia-Bello Juan Antonio, Gómez-Díaz Rita A, Contreras-Rodríguez Alicia, Talavera Juan O, Mondragón-González Rafael, Sanchez-Barbosa Lorena, Diaz-Flores Margarita, Valladares-Salgado Adan, Gallardo Juan Manuel, Aguilar-Kitsu Alejandra, Lagunas-Munoz Jesus, Wacher Niels H
Pediatr Nephrol. 2014 Feb;29(2):273-81. doi: 10.1007/s00467-013-2626-1.
We evaluated the association between inflammation and oxidative stress with carotid intima media thickness (cIMT) and elasticity increment module (E(inc)) in pediatric patients with chronic kidney disease (CKD).
This analytical, cross-sectional study assessed 134 children aged 6-17 years with CKD. Anthropometric measurements and biochemistry of intact parathyroid hormone (iPTH), high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, IL-1β, reduced glutathione (GSH), malondialdehyde, nitric oxide, and homocysteine were recorded. Bilateral carotid ultrasound (US) was taken. Patients were compared with controls for cIMT and E(inc) using ≥ 75 percentile (PC).
Mean cIMT was 0.528 ± 0.089 mm; E(inc) was 0.174 ± 0.121 kPa × 10(3); cIMT negatively correlated with phosphorus (r -0.19, p =0.028) and the calcium × phosphorus (Ca × P) product (r -0.26, p =0.002), and positively with iPTH (r 0.19,p =0.024). After adjusting for potential confounders, hemodialysis (HD) (β=0.111, p =<0.001), automated peritoneal dialysis (APD) (β=0.064, p =0.026), and Ca x P product(β=-0.002, p =0.015) predicted cIMT (R(2)=0.296). In patients on dialysis, HD (β=0.068, p =0.010), low-density lipoprotein cholesterol (LDL-C) (β=0.001, p =0.048), and GSH(β=-0.0001, p=0.041) independently predicted cIMT (R(2)=0.204); HD, hypoalbuminemia, and high iPTH increased the risk of increased cIMT. In dialysis, E(inc) was inversely associated with GSH, and in predialysis, Ca × P correlated with/predicted E(inc) (β=0.001, p =0.009).
cIMT and E(inc) strongly associate with several biochemical parameters and GSH but not with other oxidative stress or inflammation markers.
我们评估了慢性肾脏病（CKD）患儿炎症和氧化应激与颈动脉内膜中层厚度（cIMT）及弹性增加模块（E(inc)）之间的关联。
这项分析性横断面研究评估了134名6至17岁的CKD患儿。记录了人体测量数据以及完整甲状旁腺激素（iPTH）、高敏C反应蛋白（CRP）、白细胞介素（IL）-6、IL-1β、还原型谷胱甘肽（GSH）、丙二醛、一氧化氮和同型半胱氨酸的生化指标。进行了双侧颈动脉超声（US）检查。使用≥75百分位数（PC）将患者与对照组在cIMT和E(inc)方面进行比较。
平均cIMT为0.528±0.089毫米；E(inc)为0.174±0.121千帕×10(3)；cIMT与磷（r -0.19，p =0.028）以及钙×磷（Ca×P）乘积（r -0.26，p =0.002）呈负相关，与iPTH呈正相关（r 0.19，p =0.024）。在对潜在混杂因素进行校正后，血液透析（HD）（β=0.111，p =<0.001）、自动化腹膜透析（APD）（β=0.064，p =0.026）以及Ca×P乘积（β=-0.002，p =0.015）可预测cIMT（R(2)=0.296）。在接受透析的患者中，HD（β=0.068，p =0.010）、低密度脂蛋白胆固醇（LDL-C）（β=0.001，p =0.048）以及GSH（β=-0.0001，p=0.041）可独立预测cIMT（R(2)=0.204）；HD、低白蛋白血症和高iPTH会增加cIMT升高的风险。在透析过程中，E(inc)与GSH呈负相关，在透析前，Ca×P与E(inc)相关/可预测E(inc)（β=0.001，p =0.009）。
cIMT和E(inc)与多个生化参数及GSH密切相关，但与其他氧化应激或炎症标志物无关。
