腹膜透析患者血脂联素与动脉粥样硬化性疾病的关系

Association of adiponectin with atherosclerotic cardiovascular disease in CAPD patients

目的 探讨血脂联素(ADPN)与尿毒症腹膜透析(腹透)患者炎症及动脉粥样硬化 的关系。方法 采用酶联免疫复合物法测定正常对照组与59例规律性腹透患者血清ADPN水 平,并对这些腹透患者进行为期(10．0±1．7)月的随访。分析血清ADPN水平与血脂、炎症指标、 颈动脉内膜厚度、颈动脉斑块、既往心血管病(CVD)史和心血管预后的关系。结果 与正常对照 组相比,腹透组患者的血清ADPN水平显著升高[(13．09±7．54)μg／ml比(6．65±4．33)μg／ml,P= 0．001]。腹透患者血清ADPN与年龄、体重指数(BMI)、甘油三酯、C-反应蛋白(CRP)水平呈负相 关;与高密度脂蛋白(HDL)呈正相关。血清ADPN水平在有颈动脉斑块及动脉粥样硬化性心血 管疾病病史的腹透患者中较低。在随访期内有CVD事件发生组血清ADPN水平与无CVD事件 发生组相比显著降低。结论 血清ADPN水平与脂代谢异常、炎症和动脉粥样硬化性疾病有关, 血清ADPN较高的患者发生CVD事件的危险性较低。在腹透患者中,ADPN可能具有心血管的 保护作用。

Objective To investigate the relationship between serum adiponectin （ADPN） and the atherosclerotic cardiovascular diseases in peritoneal dialysis （PD） patients. Methods The serum concentrations of ADPN were detected by using ELISA. Relations of ADPN to lipid level, inflammation markers （CRP, fibrinogen, D-dimer）, intima-media thickness （IMT）, carotid plaque, history of cardiovascular diseases （CVD） aod cardiovascular reactivity were estimated in a cohort of 59 PD patients who were monitored for （10.0±1.7） months. Results Serum ADPN level of PD patients was significantly higher than that of the healthy subjects [（13.09±7.54）μg/ml vs （6.65±4.33） μg/ml, P=0.001 ]. The concentrations of serum ADPN were negatively correlated with age （r=-0.383, P 〈 0.01）, BMI（r=-0.328,P 〈 0.05）, triglycerides（r=-0.55,P 〈 0.01）, CRP（r=-0.324,P 〈 0.05）, respectively and positively correlated with HDL（r=0.496,P 〈 0.01 ）. Compared with patients without carotid plaques, the serum ADPN level was lower （P 〈 0.01） in patients with carotid plaques [ （ 15.17±7.48 ）μg/ml vs （9.60±5.09） μg/nd ]. Serum ADPN level was lower （P 〈 0.05 ） in patients with atherosclerotic cardiovascular disease （CVD） [（8.81±4.72） μg/ml] than that in those without CVD [ （13.98±8.00）μg/ml]. Serum ADPN level was also lower （P 〈 0.01） in patients who experienced new cardiovascular events [ （8.39±4.67）μg/ml] during the follow-up period than that in event-free patients [ （14.05±7.68）μg/ml]. Conclusions Serum ADPN is correlated with dyslipidemia, inflammation, and atherosclerosis, which may act as a protective factor for the cardiovascular system in PD patients.