Kuo Chiu-Huang, Lin Yu-Li, Wang Chih-Hsien, Lai Yu-Hsien, Syu Ru-Jiang, Hsu Bang-Gee
Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2018 Oct-Dec;30(4):227-232. doi: 10.4103/tcmj.tcmj_10_18.
Central arterial stiffness predicts cardiovascular (CV) mortality in hemodialysis (HD) patients. The aging process transforms lipid distribution and thus alters adipokine secretion. The harmful effects of leptin on CV events may change in the elderly. The purpose of this study was to investigate the relationship between leptin and central arterial stiffness markers through carotid-femoral pulse wave velocity (cfPWV) in geriatric HD patients.
Patients over 65 years old on chronic HD were recruited. Blood samples were collected, and the cfPWV was measured with the SphygmoCor system. The patients with cfPWV values >10 m/s were defined as the high arterial stiffness group.
In total, 30 (51.7%) of the 58 geriatric patients on chronic HD in this study were in the high arterial stiffness group. The high arterial stiffness group had higher rates of diabetes mellitus ( = 0.019), hypertension ( = 0.019), and higher systolic blood pressure ( = 0.018), pulse pressure ( = 0.019), body mass index ( = 0.018), serum leptin levels ( = 0.008), and hemoglobin levels ( = 0.040) than those in the low arterial stiffness group. Multivariable forward stepwise linear regression analysis showed logarithmically transformed leptin (log-leptin, β =0.408, adjusted change = 0.164; = 0.001) and diabetes (β =0.312, adjusted change = 0.085; = 0.009) were associated with cfPWV values in geriatric HD patients. Moreover, an increased serum leptin level (odds ratio: 1.053; 95% confidence interval: 1.007-1.100; = 0.023) was an independent factor for central arterial stiffness among geriatric HD patients after multivariate logistic regression analysis.
In this study, a higher serum leptin level was correlated with central arterial stiffness in geriatric HD patients.
中心动脉僵硬度可预测血液透析(HD)患者的心血管(CV)死亡率。衰老过程会改变脂质分布,进而改变脂肪因子的分泌。瘦素对心血管事件的有害影响在老年人中可能会有所变化。本研究的目的是通过老年HD患者的颈股脉搏波速度(cfPWV)来研究瘦素与中心动脉僵硬度标志物之间的关系。
招募65岁以上的慢性HD患者。采集血样,并用SphygmoCor系统测量cfPWV。cfPWV值>10 m/s的患者被定义为高动脉僵硬度组。
本研究中58例慢性HD老年患者中,共有30例(51.7%)属于高动脉僵硬度组。高动脉僵硬度组的糖尿病发生率(P = 0.019)、高血压发生率(P = 0.019)、收缩压(P = 0.018)、脉压(P = 0.019)、体重指数(P = 0.018)、血清瘦素水平(P = 0.008)和血红蛋白水平(P = 0.040)均高于低动脉僵硬度组。多变量向前逐步线性回归分析显示,对数转换后的瘦素(log-瘦素,β = 0.408,调整后R²变化 = 0.164;P = 0.001)和糖尿病(β = 0.312,调整后R²变化 = 0.085;P = 0.009)与老年HD患者的cfPWV值相关。此外,多变量逻辑回归分析后,血清瘦素水平升高(比值比:1.053;95%置信区间:1.007 - 1.100;P = 0.023)是老年HD患者中心动脉僵硬度的独立因素。
在本研究中,较高的血清瘦素水平与老年HD患者的中心动脉僵硬度相关。