Texas A&M Health Science Center College of Medicine, Scott & White Medical Center-Temple, Temple, TX.
Texas A&M Health Science Center College of Medicine, Scott & White Medical Center-Temple, Temple, TX.
Adv Chronic Kidney Dis. 2019 Jan;26(1):8-15. doi: 10.1053/j.ackd.2019.01.004.
Cardiovascular disease and infections are directly or indirectly associated with an altered immune response, which leads to a high incidence of morbidity and mortality, and together, they account for up to 70% of all deaths among patients with chronic kidney dysfunction. Impairment of the normal reaction of the innate and adaptive immune systems in chronic kidney disease predisposes patients to an increased risk of infections, virus-associated cancers, and a diminished vaccine response. On the other hand, an abnormal, exaggerated reaction of the immune systems can also occur in this group of patients, resulting in increased production and decreased clearance of proinflammatory cytokines, which can lead to inflammation and its sequelae (eg, atherosclerotic cardiovascular disease). Epigenetically, modifications in hematopoietic stem cells involving a shift from lymphoid to myeloid cell lineage may underlie uremia-associated immunological senescence, which is not reversed by renal replacement therapy, including kidney transplantation. Measures aimed at attenuating the immune abnormalities in chronic kidney disease/end-stage renal disease should be an area of focused research as this could potentially lead to a better understanding and, thus, development of therapies that could reduce the disastrously high death rate in this patient population. The aim of the present article is to review the characteristics, causes, and mechanisms of the immune dysfunction related to chronic kidney disease.
心血管疾病和感染与免疫反应改变直接或间接相关，导致发病率和死亡率升高，这两者共同导致慢性肾功能不全患者的死亡率高达 70%。慢性肾脏病患者固有和适应性免疫系统的正常反应受损，使他们更容易感染、感染病毒相关癌症以及疫苗反应减弱。另一方面，该人群的免疫系统也可能发生异常、过度反应，导致促炎细胞因子产生增加而清除减少，从而导致炎症及其后遗症（如动脉粥样硬化性心血管疾病）。在表观遗传学上，造血干细胞的修饰涉及从淋巴细胞向髓系细胞谱系的转变，可能是导致尿毒症相关免疫衰老的原因，而这种改变不能通过肾脏替代治疗（包括肾移植）逆转。旨在减轻慢性肾脏病/终末期肾病免疫异常的措施应成为重点研究领域，因为这可能有助于更好地理解，并因此开发出能够降低该患者人群灾难性高死亡率的治疗方法。本文旨在综述与慢性肾脏病相关的免疫功能障碍的特征、原因和机制。
