Yoon Chang-Yun, Lee Misol, Kim Seung Up, Lim Hyunsun, Chang Tae Ik, Kee Youn Kyung, Han Seung Gyu, Han In Mee, Kwon Young Eun, Park Kyoung Sook, Lee Mi Jung, Park Jung Tak, Han Seung Hyeok, Ahn Sang Hoon, Kang Shin-Wook, Yoo Tae-Hyun
Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea.
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Kidney Res Clin Pract. 2017 Mar;36(1):48-57. doi: 10.23876/j.krcp.2017.36.1.48. Epub 2017 Mar 31.
Hepatic steatosis measured with controlled attenuation parameter (CAP) using transient elastography predicts metabolic syndrome in the general population. We investigated whether CAP predicted metabolic syndrome in chronic kidney disease patients.
CAP was measured with transient elastography in 465 predialysis chronic kidney disease patients (mean age, 57.5 years).
The median CAP value was 239 (202-274) dB/m. In 195 (41.9%) patients with metabolic syndrome, diabetes mellitus was more prevalent (105 [53.8%] vs. 71 [26.3%], < 0.001), with significantly increased urine albumin-to-creatinine ratio (184 [38-706] vs. 56 [16-408] mg/g Cr, = 0.003), high sensitivity C-reactive protein levels (5.4 [1.4-28.2] vs. 1.7 [0.6-9.9] mg/L, < 0.001), and CAP (248 [210-302] vs. 226 [196-259] dB/m, < 0.001). In multiple linear regression analysis, CAP was independently related to body mass index (β = 0.742, < 0.001), triglyceride levels (β = 2.034, < 0.001), estimated glomerular filtration rate (β = 0.316, = 0.001), serum albumin (β = 1.386, < 0.001), alanine aminotransferase (β = 0.064, = 0.029), and total bilirubin (β = -0.881, = 0.009). In multiple logistic regression analysis, increased CAP was independently associated with increased metabolic syndrome risk (per 10 dB/m increase; odds ratio, 1.093; 95% confidence interval, 1.009-1.183; = 0.029) even after adjusting for multiple confounding factors.
Increased CAP measured with transient elastography significantly correlated with and could predict increased metabolic syndrome risk in chronic kidney disease patients.
使用瞬时弹性成像技术通过控制衰减参数（CAP）测量的肝脂肪变性可预测普通人群中的代谢综合征。我们研究了CAP是否能预测慢性肾脏病患者的代谢综合征。
对465例透析前慢性肾脏病患者（平均年龄57.5岁）进行瞬时弹性成像测量CAP。
CAP的中位数为239（202 - 274）dB/m。在195例（41.9%）患有代谢综合征的患者中，糖尿病更为普遍（105例[53.8%]对71例[26.3%]，P < 0.001），尿白蛋白与肌酐比值显著升高（184[38 - 706]对56[16 - 408]mg/g Cr，P = 0.003），高敏C反应蛋白水平升高（5.4[1.4 - 28.2]对1.7[0.6 - 9.9]mg/L，P < 0.001），且CAP升高（248[210 - 302]对226[196 - 259]dB/m，P < 0.001）。在多元线性回归分析中，CAP与体重指数（β = 0.742，P < 0.001）、甘油三酯水平（β = 2.034，P < 0.001）、估计肾小球滤过率（β = 0.316，P = 0.001）、血清白蛋白（β = 1.386，P < 0.001）、丙氨酸氨基转移酶（β = 0.064，P = 0.029）和总胆红素（β = -0.881，P = 0.009）独立相关。在多元逻辑回归分析中，即使在调整了多个混杂因素后，CAP升高仍与代谢综合征风险增加独立相关（每增加10 dB/m；比值比，1.093；95%置信区间，1.009 - 1.183；P = 0.029）。
通过瞬时弹性成像测量的CAP升高与慢性肾脏病患者代谢综合征风险增加显著相关且可预测该风险增加。
