一项测量慢性肾脏病儿科患者钒和铬水平的横断面研究。
A cross-sectional study measuring vanadium and chromium levels in paediatric patients with CKD.
作者信息
Filler Guido, Kobrzynski Marta, Sidhu Hargun Kaur, Belostotsky Vladimir, Huang Shih-Han S, McIntyre Chris, Yang Liju
机构信息
Department of Paediatrics, Division of Paediatric Nephrology, Children's Hospital, London, Ontario, Canada.
Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada.
出版信息
BMJ Open. 2017 Jun 6;7(5):e014821. doi: 10.1136/bmjopen-2016-014821.
OBJECTIVES
Although many secondary effects of high levels of vanadium (V) and chromium (Cr) overlap with symptoms seen in paediatric patients with chronic kidney disease (CKD), their plasma V and Cr levels are understudied.
DESIGN
Ancillary cross-sectional study to a prospective, longitudinal, randomised controlled trial.
SETTING
Children's Hospital of Western Ontario, London Health Sciences Centre, London, Ontario, Canada.
PARTICIPANTS
36 children and adolescents 4-18 years of age with CKD.
INTERVENTIONS
1-6 trace element measurements per patient. Cystatin C (CysC) estimated glomerular filtration rate (eGFR) was calculated using the Filler formula. Plasma V and Cr levels were measured using high-resolution sector field inductively coupled mass spectrometry. Anthropomorphic data and blood parameters were collected from our electronic chart programme. Water Cr and V data were obtained from the Ontario Water (Stream) Quality Monitoring Network.
PRIMARY AND SECONDARY OUTCOME MEASURES
Primary outcomes: plasma Cr and V.
SECONDARY OUTCOMES
age, season, CysC, CysC eGFR, and Cr and V levels in environmental water.
RESULTS
The median (IQR) eGFR was 51 mL/min/1.73 m (35, 75). The median V level was 0.12 µg/L (0.09, 0.18), which was significantly greater than the 97.5th percentile of the reference interval of 0.088 µg/L; 32 patients had at least one set of V levels above the published reference interval. The median Cr level was 0.43 µg/L (0.36, 0.54), which was also significantly greater than the established reference interval; 34 had at least one set of Cr levels above the published reference interval. V and Cr levels were moderately correlated. Only some patients had high environmental exposure.
CONCLUSIONS
Our study suggests that paediatric patients with CKD have elevated plasma levels of V and Cr. This may be the result of both environmental exposure and a low eGFR. It may be necessary to monitor V and Cr levels in patients with an eGFR <30 mL/min/1.73 m.
TRIAL REGISTRATION NUMBER
NCT02126293; HC#172241.
目的
尽管高浓度钒（V）和铬（Cr）的许多次要影响与慢性肾脏病（CKD）儿科患者的症状重叠，但其血浆V和Cr水平仍未得到充分研究。
设计
一项前瞻性、纵向、随机对照试验的辅助横断面研究。
地点
加拿大安大略省伦敦市西安大略儿童医院、伦敦健康科学中心。
参与者
36名4至18岁的CKD儿童和青少年。
干预措施
每位患者进行1至6次微量元素测量。使用Filler公式计算胱抑素C（CysC）估计肾小球滤过率（eGFR）。使用高分辨率扇形场电感耦合质谱法测量血浆V和Cr水平。从我们的电子病历程序中收集人体测量数据和血液参数。水Cr和V数据来自安大略省水质（河流）监测网络。
主要和次要结局指标
主要结局：血浆Cr和V。
次要结局
年龄、季节、CysC、CysC eGFR以及环境水中的Cr和V水平。
结果
eGFR的中位数（IQR）为51 mL/min/1.73 m²（35，75）。V水平的中位数为0.12 μg/L（0.09，0.18），显著高于参考区间97.5%位数的0.088 μg/L；32名患者至少有一组V水平高于已发表的参考区间。Cr水平的中位数为0.43 μg/L（0.36，0.54），也显著高于既定参考区间；34名患者至少有一组Cr水平高于已发表的参考区间。V和Cr水平呈中度相关。只有部分患者有高环境暴露。
结论
我们的研究表明，CKD儿科患者的血浆V和Cr水平升高。这可能是环境暴露和低eGFR共同作用的结果。对于eGFR<30 mL/min/1.73 m²的患者，可能有必要监测V和Cr水平。
试验注册号
NCT02126293；HC#172241。
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