鸢尾素与容量超负荷与腹膜透析患者的蛋白质能量消耗相关。
Irisin and Volume Overload are Associated with Protein Energy Wasting in Peritoneal Dialysis Patients.
出版信息
Kidney Blood Press Res. 2017;42(6):1216-1224. doi: 10.1159/000485925. Epub 2017 Dec 14.
BACKGROUND/AIMS: Protein energy wasting (PEW) is a common medical phenomenon that is observed in maintenance dialysis patients. PEW also increases morbidity and mortality of these patients. Its pathogenesis is unclear. We hypothesize that serum irisin levels and volume overload may induce PEW in peritoneal dialysis (PD) patients. The aim of this study is to measure serum irisin levels, evaluate volume status of PD patients, and study their correlations with PEW in PD patients.
METHODS
This study is a cross-sectional study with 160 PD patients from the PD center of Peking University Third Hospital and 35 healthy control subjects. PD patients were divided into PEW group and non-PEW group according to PEW diagnosis criteria. Serum irisin concentrations were measured by ELISA. Volume overload status (volume overload is defined as overhydration value ≥2 liters) of PD patients was analyzed by bioelectrical impedance.
RESULTS
The serum irisin levels were significantly lower in PD patients compared with those of the controls (113.2±11.8 ng/ml vs. 464.2±37.4 ng/ml, P<0.01). The serum irisin levels were lower in PD patients with PEW than those of the patients without PEW (106.5±15.2 ng/ml vs. 117.4±17.6 ng/ml, P<0.01). PEW is more prevalent in patients with volume overload than patients without volume overload (62.5% vs. 43.1%, x2=5.756, P=0.016); however, no direct relationship was found between irisin levels and volume overload status. The independent influencing factors of PEW were serum irisin, serum albumin, and volume overload.
CONCLUSION
Our results are the first to provide clinical evidence of the association between serum irisin, volume overload, and PEW in PD patients. PEW may inhibit the release or synthesis of irisin from skeletal muscles, and volume overload may aggravate PEW in PD patients.
背景/目的：蛋白能量消耗（PEW）是维持性透析患者中常见的医学现象，也会增加这些患者的发病率和死亡率。其发病机制尚不清楚。我们假设血清鸢尾素水平和容量超负荷可能会导致腹膜透析（PD）患者发生 PEW。本研究旨在测量血清鸢尾素水平，评估 PD 患者的容量状态，并研究其与 PD 患者 PEW 的相关性。
方法
这是一项横断面研究，纳入了来自北京大学第三医院 PD 中心的 160 名 PD 患者和 35 名健康对照者。根据 PEW 诊断标准，将 PD 患者分为 PEW 组和非 PEW 组。通过 ELISA 法测量血清鸢尾素浓度。通过生物电阻抗法分析 PD 患者的容量超负荷状态（定义为超水量值≥2 升）。
结果
与对照组相比，PD 患者的血清鸢尾素水平明显降低（113.2±11.8ng/ml 比 464.2±37.4ng/ml，P<0.01）。与非 PEW 患者相比，PEW 患者的血清鸢尾素水平更低（106.5±15.2ng/ml 比 117.4±17.6ng/ml，P<0.01）。与无容量超负荷患者相比，有容量超负荷患者中 PEW 的发生率更高（62.5%比 43.1%，x2=5.756，P=0.016）；然而，鸢尾素水平与容量超负荷状态之间没有直接关系。PEW 的独立影响因素是血清鸢尾素、血清白蛋白和容量超负荷。
结论
本研究结果首次提供了 PD 患者血清鸢尾素、容量超负荷与 PEW 之间关联的临床证据。PEW 可能抑制骨骼肌释放或合成鸢尾素，而容量超负荷可能加重 PD 患者的 PEW。
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