Salama Farag E, Anass Qasem A, Abdelrahman Abdelnaem A, Saeed Elsayed B
Department of Internal Medicine, Zagazig University, Zagazig, Egypt.
Department of Clinical Pathology, Zagazig University, Zagazig, Egypt.
Saudi J Kidney Dis Transpl. 2016 Sep-Oct;27(5):977-984. doi: 10.4103/1319-2442.190867.
Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). The carotid intima-media thickness (CIMT) and arterial stiffness are useful markers of subclinical atherosclerosis and significantly correlate with various metabolic risk factors. Chemerin is one of the adipokines that may represent a link between obesity and inflammation and may be a potential candidate playing a role in the pathogenesis of atherosclerosis and cardiovascular complications. Therefore, we studied the relationship of chemerin levels with atherosclerosis as measured by CIMT in diabetic CKD patients, either predialysis or on hemodialysis (HD). In addition, we studied its correlation with other cardiovascular risk factors such as interleukin-6 (IL-6) and insulin resistance (IR). Fifty-eight patients were enrolled in the study; 23 patients with CKD (11 are diabetic) on conservative treatment and 35 (18 are diabetic) on maintenance HD. Serum concentrations of chemerin and IL-6 were determined by ELISA. All participants underwent measurements of CIMT by highresolution ultrasonography. A stepwise increase in serum chemerin levels was found depending on the glomerular filtration rate: 286.6 ± 10.02 ng/mL in the control group, 332.1 ± 21.54 ng/mL in the predialysis group, and 355.7 ± 20 ng/mL in the HD group. A significant rise of serum chemerin level was observed in diabetic CKD patients either on conservative therapy or on HD when compared with nondiabetic CKD patients. Moreover, there was a significant difference in serum levels of chemerin, IL-6, CIMT, serum insulin, and homeostasis model assessment of IR (HOMA-IR) between diabetic and nondiabetic patients in both groups. Chemerin showed a significant positive correlation with HOMA-IR, serum insulin, and C-reactive protein. In conclusion, serum chemerin level was found to be an independent predictive marker of the presence of atherosclerosis in patients with CKD either on conservative treatment or on HD.
心血管疾病是慢性肾脏病（CKD）患者发病和死亡的主要原因。颈动脉内膜中层厚度（CIMT）和动脉僵硬度是亚临床动脉粥样硬化的有用标志物，且与多种代谢危险因素显著相关。趋化素是一种脂肪因子，可能是肥胖与炎症之间的联系纽带，可能是在动脉粥样硬化和心血管并发症发病机制中起作用的潜在候选因素。因此，我们研究了在糖尿病CKD患者（无论是透析前还是血液透析（HD）患者）中，趋化素水平与通过CIMT测量的动脉粥样硬化之间的关系。此外，我们研究了它与其他心血管危险因素如白细胞介素-6（IL-6）和胰岛素抵抗（IR）的相关性。58名患者纳入本研究；23名接受保守治疗的CKD患者（11名患有糖尿病）和35名维持性HD患者（18名患有糖尿病）。采用酶联免疫吸附测定法（ELISA）测定趋化素和IL-6的血清浓度。所有参与者均通过高分辨率超声测量CIMT。根据肾小球滤过率发现血清趋化素水平呈逐步升高：对照组为286.6±10.02 ng/mL，透析前组为332.1±21.54 ng/mL，HD组为355.7±20 ng/mL。与非糖尿病CKD患者相比，接受保守治疗或HD的糖尿病CKD患者血清趋化素水平显著升高。此外，两组糖尿病和非糖尿病患者之间趋化素、IL-6、CIMT、血清胰岛素和IR的稳态模型评估（HOMA-IR）的血清水平存在显著差异。趋化素与HOMA-IR、血清胰岛素和C反应蛋白呈显著正相关。总之，发现血清趋化素水平是接受保守治疗或HD的CKD患者动脉粥样硬化存在的独立预测标志物。
