血液透析期间血浆 copeptin 水平的变化：生理刺激在血液透析患者中是否起作用？
Changes in Plasma Copeptin Levels during Hemodialysis: Are the Physiological Stimuli Active in Hemodialysis Patients?
作者信息
Ettema Esmée M, Kuipers Johanna, Assa Solmaz, Bakker Stephan J L, Groen Henk, Westerhuis Ralf, Gaillard Carlo A J M, Gansevoort Ron T, Franssen Casper F M
机构信息
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Dialysis Center Groningen, Groningen, The Netherlands.
出版信息
PLoS One. 2015 May 14;10(5):e0127116. doi: 10.1371/journal.pone.0127116. eCollection 2015.
OBJECTIVES
Plasma levels of copeptin, a surrogate marker for the vasoconstrictor hormone arginine vasopressin (AVP), are increased in hemodialysis patients. Presently, it is unknown what drives copeptin levels in hemodialysis patients. We investigated whether the established physiological stimuli for copeptin release, i.e. plasma osmolality, blood volume and mean arterial pressure (MAP), are operational in hemodialysis patients.
METHODS
One hundred and eight prevalent, stable hemodialysis patients on a thrice-weekly dialysis schedule were studied during hemodialysis with constant ultrafiltration rate and dialysate conductivity in this observational study. Plasma levels of copeptin, sodium, MAP, and blood volume were measured before, during and after hemodialysis. Multivariate analysis was used to determine the association between copeptin (dependent variable) and the physiological stimuli plasma sodium, MAP, excess weight as well as NT-pro-BNP immediately prior to dialysis and between copeptin and changes of plasma sodium, MAP and blood volume with correction for age, sex and diabetes during dialysis treatment.
RESULTS
Patients were 63 ± 15.6 years old and 65% were male. Median dialysis vintage was 1.6 years (IQR 0.7-4.0). Twenty-three percent of the patients had diabetes and 82% had hypertension. Median predialysis copeptin levels were 141.5 pmol/L (IQR 91.0-244.8 pmol/L). Neither predialysis plasma sodium levels, nor NT-proBNP levels, nor MAP were associated with predialysis copeptin levels. During hemodialysis, copeptin levels rose significantly (p<0.01) to 163.0 pmol/L (96.0-296.0 pmol/L). Decreases in blood volume and MAP were associated with increases in copeptin levels during dialysis, whereas there was no significant association between the change in plasma sodium levels and the change in copeptin levels.
CONCLUSIONS
Plasma copeptin levels are elevated predialysis and increase further during hemodialysis. Volume stimuli, i.e. decreases in MAP and blood volume, rather than osmotic stimuli, are associated with change in copeptin levels during hemodialysis.
目的
血管加压素（AVP）的替代标志物copeptin的血浆水平在血液透析患者中升高。目前，尚不清楚是什么因素驱动血液透析患者的copeptin水平。我们研究了既定的copeptin释放生理刺激因素，即血浆渗透压、血容量和平均动脉压（MAP），在血液透析患者中是否起作用。
方法
在这项观察性研究中，对108例按每周三次透析方案进行透析的稳定的维持性血液透析患者进行研究，透析过程中维持恒定的超滤率和透析液电导率。在血液透析前、透析期间和透析后测量copeptin、钠、MAP和血容量的血浆水平。多变量分析用于确定copeptin（因变量）与透析前生理刺激因素血浆钠、MAP、超重以及NT-pro-BNP之间的关联，以及copeptin与透析治疗期间校正年龄、性别和糖尿病因素后的血浆钠、MAP和血容量变化之间的关联。
结果
患者年龄为63±15.6岁，65%为男性。透析中位时间为1.6年（四分位间距0.7 - 4.0年）。23%的患者患有糖尿病，82%的患者患有高血压。透析前copeptin水平中位数为141.5 pmol/L（四分位间距91.0 - 244.8 pmol/L）。透析前血浆钠水平、NT-proBNP水平和MAP均与透析前copeptin水平无关。血液透析期间，copeptin水平显著升高（p<0.01）至163.0 pmol/L（96.0 - 296.0 pmol/L）。透析期间血容量和MAP的降低与copeptin水平的升高相关，而血浆钠水平的变化与copeptin水平的变化之间无显著关联。
结论
透析前血浆copeptin水平升高，血液透析期间进一步升高。容量刺激因素，即MAP和血容量的降低，而非渗透刺激因素，与血液透析期间copeptin水平的变化相关。
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