IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, 10 Largo Rosanna Benzi, 16132 Genoa, Italy; First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.
Clinical Epidemiology of Renal Disease and Hypertension Unit. Reggio Cal CNR Unit of the Pisa CNR Institute of Clinical Physiology, Italy.
Eur J Intern Med. 2024 Nov;129:87-92. doi: 10.1016/j.ejim.2024.07.013. Epub 2024 Jul 16.
In patients with kidney failure (KF) undergoing dialysis, neutrophils are dysfunctionally activated. Such chronic activation does not correspond to increased protection against infections and is thought to cause direct vascular damage accounting for the higher incidence of cardiovascular (CV) events. We hypothesized that circulating levels of neutrophil degranulation products (i.e. myeloperoxidase (MPO) and resistin) can predict overall and CV-specific mortality in dialysis patients.
MPO and resistin levels were assessed in plasma samples from n = 1182 dialysis patients who were followed-up for median 2.9 years (IQR: 1.7-4.2).
Patients were 65 ± 14 (SD) years old and 36 % women. Median value of MPO and resistin were 78 ng/mL (IQR: 54 - 123) and 72 ng/mL (IQR: 46 - 110), respectively. MPO and resistin levels correlated with biomarkers of organ damage, nutritional status and inflammation. Both MPO and resistin levels predicted all-cause mortality even after adjustment for traditional risk factors and inflammation, nutritional and KF-related indexes (MPO, HR: 1.26, 95 %CI 1.11 - 1.42, P < 0.001; Resistin, HR: 1.25, 95 %CI 1.09 - 1.44, P = 0.001). Similarly, their predictive ability held true also for CV death (MPO, HR: 1.19, 95 %CI 1.01 - 1.41, P = 0.04; Resistin, HR: 1.29, 95 %CI 1.07 - 1.56, P = 0.007).
Plasma levels of MPO and resistin correlate with prospective overall and CV-specific mortality risk in KF patients undergoing dialysis and might be useful prognostic tools. Mediators of inflammation may be potential target to improve survival of those patients.
在接受透析的肾衰竭（KF）患者中，中性粒细胞功能失调地被激活。这种慢性激活并不能对应增加对感染的保护作用，并且被认为会导致直接的血管损伤，从而导致更高的心血管（CV）事件发生率。我们假设循环中性粒细胞脱颗粒产物（即髓过氧化物酶（MPO）和抵抗素）的水平可以预测透析患者的总死亡率和 CV 特异性死亡率。
评估了 n = 1182 名透析患者的血浆样本中的 MPO 和抵抗素水平，这些患者的中位随访时间为 2.9 年（IQR：1.7-4.2）。
患者年龄为 65 ± 14（SD）岁，女性占 36%。MPO 和抵抗素的中位数分别为 78ng/mL（IQR：54-123）和 72ng/mL（IQR：46-110）。MPO 和抵抗素水平与器官损伤、营养状况和炎症的生物标志物相关。MPO 和抵抗素水平即使在调整传统危险因素和炎症、营养和 KF 相关指标后，也可以预测全因死亡率（MPO，HR：1.26，95%CI 1.11-1.42，P<0.001；抵抗素，HR：1.25，95%CI 1.09-1.44，P=0.001）。同样，它们对 CV 死亡的预测能力也是如此（MPO，HR：1.19，95%CI 1.01-1.41，P=0.04；抵抗素，HR：1.29，95%CI 1.07-1.56，P=0.007）。
MPO 和抵抗素的血浆水平与接受透析的 KF 患者的总体前瞻性和 CV 特异性死亡风险相关，并且可能是有用的预后工具。炎症的介质可能是改善这些患者生存的潜在目标。
