Divisione di Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
Università Cattolica del Sacro Cuore, Roma, Italy; UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Cytokine. 2020 Jan;125:154823. doi: 10.1016/j.cyto.2019.154823. Epub 2019 Sep 18.
Little is known about the underlying aetiology of fatigue in haemodialysis (HD) patients apart from a significant association and overlapping symptomatology with depressive symptoms. Growing evidence exists for the involvement of the immune system, by pro-inflammatory cytokines, in the development of fatigue in other inflammatory diseases. In HD patients, increased exposure to bacterial endotoxins may contribute to an inflammatory response and may potentially lead to fatigue. We therefore aimed (i) to assess the interrelationship between serum endotoxin (EA) levels, interleukin-6 (IL-6) levels and fatigue in HD patients; (ii) to evaluate whether there is a relationship between depressive symptoms and inflammation as well and (iii) to what extent depressive symptoms and fatigue are related to each other.
Fatigue and depressive symptoms in daily life were assessed in 59 individuals using the SF-36 vitality subscale and the Geriatric Depression Scale. Blood samples were collected on a mid-week dialysis session to determine EA levels, through the Endotoxin Activity Assay (EAA™), and IL-6 concentrations, through the commercially available Abcam ELISA (Enzyme-Linked Immunosorbent Assay) kit.
EA, IL-6 levels and depressive symptoms were significantly correlated with fatigue. EA levels and depressive symptoms were significant predictors of fatigue, explaining 31% of its variance. However, EA and IL-6 were not significantly associated with depression.
Fatigue in HD patients may be related to endotoxemia and inflammation through IL-6. Furthermore, fatigue is significantly associated with depressive symptoms. Future research into the causal interrelationship of inflammation, fatigue and depression in HD patients might lead to potential targets for therapeutic strategies.
除了与抑郁症状显著相关和重叠外，血液透析（HD）患者的疲劳的潜在病因知之甚少。越来越多的证据表明，促炎细胞因子参与了其他炎症性疾病中疲劳的发生。在 HD 患者中，内毒素（EA）水平的增加可能会导致炎症反应，并可能导致疲劳。因此，我们旨在（i）评估 HD 患者血清内毒素（EA）水平、白细胞介素-6（IL-6）水平与疲劳之间的相互关系；（ii）评估抑郁症状与炎症之间是否存在关系；（iii）评估抑郁症状和疲劳之间的关系。
使用 SF-36 活力量表和老年抑郁量表在 59 名个体中评估日常生活中的疲劳和抑郁症状。在每周透析期间采集血液样本，通过内毒素活性测定法（EAA™）测定 EA 水平，并通过市售的 Abcam ELISA（酶联免疫吸附测定）试剂盒测定 IL-6 浓度。
EA、IL-6 水平和抑郁症状与疲劳显著相关。EA 水平和抑郁症状是疲劳的显著预测因素，可解释其 31%的变异。然而，EA 和 IL-6 与抑郁无显著相关性。
HD 患者的疲劳可能与内毒素血症和通过 IL-6 引起的炎症有关。此外，疲劳与抑郁症状显著相关。对 HD 患者中炎症、疲劳和抑郁之间因果关系的进一步研究可能会为治疗策略提供潜在目标。
