Ficek Joanna, Wyskida Katarzyna, Ficek Rafał, Wajda Jarosław, Klein Dariusz, Witkowicz Joanna, Rotkegel Sylwia, Spiechowicz-Zatoń Urszula, Kocemba-Dyczek Joanna, Ciepał Jarosław, Więcek Andrzej, Olszanecka-Glinianowicz Magdalena, Chudek Jerzy
Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice, Medical University of Silesia, Medyków 18 Street, 40-752, Katowice, Poland.
Health Promotion and Obesity Management Unit, Department of Pathophysiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
Int Urol Nephrol. 2017 Apr;49(4):717-725. doi: 10.1007/s11255-016-1495-5. Epub 2017 Jan 2.
Increased permeability of the intestinal wall and intestinal dysbiosis may contribute to chronic systemic inflammation, one of the causes of accelerated atherosclerosis and cardiovascular morbidity and mortality burden in patients with chronic kidney disease. The aim of this study was to evaluate the association between markers of intestinal permeability and inflammation in haemodialysis (HD) patients.
Plasma concentration of zonulin, haptoglobin, TNFα, IL6, D-lactates and bacterial lipopolysaccharides (LPS) was assessed in blood samples obtained after overnight fast before midweek morning HD session in 150 stable, prevalent HD patients. Daily intake of energy and macronutrients was assessed on the basis of a food frequency questionnaire.
Serum hsCRP level was increased in over 70% of patients. Plasma levels of zonulin [11.6 (10.9-12.3) vs 6.8 (5.8-7.8) ng/mL], IL6 [6.2 (1.0-10.3) vs 1.3 (1.0-2.0) pg/mL] and TNFα [5.9 (2.9-11.8) vs 1.6 (1.3-1.8) pg/mL], but not LPS and D-lactates were significantly higher in HD than in healthy controls. D-lactates and LPS levels were weakly associated with IL6 (R = 0.175; p = 0.03, and R = 0.241; p = 0.003). There was a borderline correlation between plasma zonulin and serum hsCRP (R = 0.159; p = 0.07), but not with IL6, LPS and D-lactates. In multiple regression, both serum CRP and plasma IL6 variability were explained by LPS (β = 0.143; p = 0.08 and β = 0.171; p = 0.04, respectively), only.
The weak association between plasma D-lactate, LPS and IL6 levels indicates that intestinal flora overgrowth or increased intestinal permeability contributes very slightly to the chronic inflammation development in HD patients.
肠壁通透性增加和肠道菌群失调可能导致慢性全身炎症，这是慢性肾脏病患者动脉粥样硬化加速及心血管疾病发病和死亡负担加重的原因之一。本研究旨在评估血液透析（HD）患者肠道通透性标志物与炎症之间的关联。
在150例病情稳定的HD患者周中上午透析前空腹采集血样，检测血浆中闭合蛋白、触珠蛋白、肿瘤坏死因子α（TNFα）、白细胞介素6（IL6）、D-乳酸和细菌脂多糖（LPS）的浓度。根据食物频率问卷评估能量和常量营养素的每日摄入量。
超过70%的患者血清超敏C反应蛋白（hsCRP）水平升高。HD患者血浆中闭合蛋白[11.6（10.9 - 12.3）对6.8（5.8 - 7.8）ng/mL]、IL6[6.2（1.0 - 10.3）对1.3（1.0 - 2.0）pg/mL]和TNFα[5.9（2.9 - 11.8）对1.6（1.3 - 1.8）pg/mL]水平显著高于健康对照，而LPS和D-乳酸水平无显著差异。D-乳酸和LPS水平与IL6呈弱相关（R = 0.175；p = 0.03，以及R = 0.241；p = 0.003）。血浆闭合蛋白与血清hsCRP之间存在临界相关性（R = 0.159；p = 0.07），但与IL6、LPS和D-乳酸无相关性。在多元回归分析中，血清CRP和血浆IL6的变异性仅由LPS解释（β分别为0.143；p = 0.08和β = 0.171；p = 0.04）。
血浆D-乳酸、LPS和IL6水平之间的弱关联表明，肠道菌群过度生长或肠道通透性增加对HD患者慢性炎症发展的影响非常小。
