Tung Chun-Wu, Hsu Yung-Chien, Shih Ya-Hsueh, Lin Chun-Liang
Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi, Taiwan; Chronic Kidney Disease Center, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi, Taiwan; Chronic Kidney Disease Center, Chang Gung Memorial Hospital, Chiayi, Taiwan.
PLoS One. 2015 Oct 16;10(10):e0141058. doi: 10.1371/journal.pone.0141058. eCollection 2015.
Adiponectin (ADPN), one of most abundant fat-derived biologically active substances, plays an important role in anti-atherosclerotic process. There are conflicting results about the impact of ADPN on cardiovascular (CV) outcomes and mortality, particularly in patients undergoing peritoneal dialysis (PD). Moreover, the relationship between ADPN and inflammatory mediators has been seldom explored in this population. Therefore, we examined the relationship between ADPN and longitudinal high-sensitivity C-reactive protein (hs-CRP) changes and investigated whether ADPN or hs-CRP levels could predict CV outcomes and mortality in prevalent PD patients after comprehensive adjustment of possible confounders.
In this prospective cohort study, 78 PD patients were enrolled and followed from February 2009 to August 2012. During follow-up, CV events and all-cause mortality were recorded.
The mean baseline ADPN value was 29.46±18.01 μg/ml and duration of PD treatment was 37.76±36.96 months. In multiple linear regression analysis, plasma ADPN levels positively correlated with high-density lipoprotein and negatively associated with hs-CRP, body mass index, D4/D0 glucose, triglyceride, and duration of PD treatment. After stratified by genders, the inverse association between baseline ADPN and hs-CRP was more significant in the female group. The hs-CRP levels were followed up annually and remained significantly lower in the high ADPN group in the first 2 years. Patients were then stratified into two groups according to the median ADPN value (23.8 μg/ml). The results of Kaplan-Meier survival analysis demonstrated less CV events and better survival in high ADPN group. On multivariate Cox regression analysis, only ADPN level (HR: 0.93, 95% CI: 0.88-0.98, p = 0.02), age and history of CV diseases were independent risk factors for future CV events. Furthermore, hs-CRP (HR: 1.11, 95% CI:1.001-1.22, p = 0.04) was identified as independent predictor of all-cause mortality.
Serum hs-CRP levels were consistently lower in the high ADPN group during 2-year follow-up. We also demonstrated the importance of ADPN and hs-CRP in predicting CV events and all-cause mortality in PD population during 3.5-year follow-up.
脂联素（ADPN）是最丰富的脂肪源性生物活性物质之一，在抗动脉粥样硬化过程中发挥重要作用。关于ADPN对心血管（CV）结局和死亡率的影响，存在相互矛盾的结果，尤其是在接受腹膜透析（PD）的患者中。此外，在这一人群中，ADPN与炎症介质之间的关系很少被探讨。因此，我们研究了ADPN与纵向高敏C反应蛋白（hs-CRP）变化之间的关系，并在全面调整可能的混杂因素后，调查了ADPN或hs-CRP水平是否能够预测PD患者的CV结局和死亡率。
在这项前瞻性队列研究中，纳入了78例PD患者，并于2009年2月至2012年8月进行随访。随访期间，记录CV事件和全因死亡率。
ADPN的平均基线值为29.46±18.01μg/ml，PD治疗时间为37.76±36.96个月。在多元线性回归分析中，血浆ADPN水平与高密度脂蛋白呈正相关，与hs-CRP、体重指数、D4/D0血糖、甘油三酯和PD治疗时间呈负相关。按性别分层后，基线ADPN与hs-CRP之间的负相关在女性组中更显著。每年对hs-CRP水平进行随访，在前两年中，高ADPN组的hs-CRP水平仍显著较低。然后根据ADPN中位数（23.8μg/ml）将患者分为两组。Kaplan-Meier生存分析结果显示，高ADPN组的CV事件较少，生存率更高。在多因素Cox回归分析中，只有ADPN水平（HR：0.93，95%CI：0.88-0.98，p = 0.02）、年龄和CV疾病史是未来CV事件的独立危险因素。此外，hs-CRP（HR：1.11，95%CI：1.001-1.22，p = 0.04）被确定为全因死亡率的独立预测因素。
在2年的随访中，高ADPN组的血清hs-CRP水平一直较低。我们还证明了在3.5年的随访中，ADPN和hs-CRP在预测PD人群的CV事件和全因死亡率方面的重要性。
