Szeto Cheuk-Chun, Kwan Bonnie Ching-Ha, Chow Kai-Ming, Kwok Jeffrey Sung-Shing, Lai Ka-Bik, Cheng Phyllis Mei-Shan, Pang Wing-Fai, Ng Jack Kit-Chung, Chan Michael Ho-Ming, Lit Lydia Choi-Wan, Leung Chi-Bon, Li Philip Kam-Tao
Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
PLoS One. 2015 May 26;10(5):e0125162. doi: 10.1371/journal.pone.0125162. eCollection 2015.
Circulating bacterial DNA fragment is related to systemic inflammatory state in peritoneal dialysis (PD) patients. We hypothesize that plasma bacterial DNA level predicts cardiovascular events in new PD patients.
We measured plasma bacterial DNA level in 191 new PD patients, who were then followed for at least a year for the development of cardiovascular event, hospitalization, and patient survival.
The average age was 59.3 ± 11.8 years; plasma bacterial DNA level 34.9 ± 1.5 cycles; average follow up 23.2 ± 9.7 months. At 24 months, the event-free survival was 86.1%, 69.8%, 55.4% and 30.8% for plasma bacterial DNA level quartiles I, II, III and IV, respectively (p < 0.0001). After adjusting for confounders, plasma bacterial DNA level, baseline residual renal function and malnutrition-inflammation score were independent predictors of composite cardiovascular end-point; each doubling in plasma bacterial DNA level confers a 26.9% (95% confidence interval, 13.0 - 42.5%) excess in risk. Plasma bacterial DNA also correlated with the number of hospital admission (r = -0.379, p < 0.0001) and duration of hospitalization for cardiovascular reasons (r = -0.386, p < 0.0001). Plasma bacterial DNA level did not correlate with baseline arterial pulse wave velocity (PWV), but with the change in carotid-radial PWV in one year (r = -0.238, p = 0.005).
Circulating bacterial DNA fragment level is a strong predictor of cardiovascular event, need of hospitalization, as well as the progressive change in arterial stiffness in new PD patients.
循环细菌DNA片段与腹膜透析（PD）患者的全身炎症状态相关。我们假设血浆细菌DNA水平可预测新的PD患者发生心血管事件的风险。
我们检测了191例新的PD患者的血浆细菌DNA水平，随后对这些患者进行了至少一年的随访，观察心血管事件的发生、住院情况及患者生存情况。
患者平均年龄为59.3±11.8岁；血浆细菌DNA水平为34.9±1.5个循环；平均随访时间为23.2±9.7个月。在24个月时，血浆细菌DNA水平四分位数I、II、III和IV的无事件生存率分别为86.1%、69.8%、55.4%和30.8%（p<0.0001）。在对混杂因素进行校正后，血浆细菌DNA水平、基线残余肾功能和营养不良-炎症评分是复合心血管终点的独立预测因素；血浆细菌DNA水平每增加一倍，风险增加26.9%（95%置信区间，13.0 - 42.5%）。血浆细菌DNA还与住院次数（r = -0.379，p<0.0001）及因心血管原因住院的时间（r = -0.386，p<0.0001）相关。血浆细菌DNA水平与基线动脉脉搏波速度（PWV）无关，但与一年内颈-桡动脉PWV的变化相关（r = -0.238，p = 0.005）。
循环细菌DNA片段水平是新的PD患者发生心血管事件、住院需求以及动脉僵硬度进展变化的有力预测指标。
