透析患者血浆Adiponectin水平和影响因素

A study of plasma Adiponectin levels and related factors in maintenance hemodialysis and peritoneal dialysis patients

目的观察维持性血液透析和腹膜透析患者血浆Adiponectin(ADPN)水平,探讨其相关影响因素。方法选择北京大学第三医院肾内科健康对照组20例,病情稳定的维持性血液透析患者30例,腹膜透析患者30例,ELISA方法测定3组研究对象的空腹血浆ADPN,每例透析患者测定血清白介素IL-6(IL-6)和肿瘤坏死因子(TNF-α),C反应蛋白,前白蛋白,转铁蛋白,血清甘油三酯,总胆固醇,计算KT/V,主观营养综合评估(SGA)透析患者的营养状况。结果①维持性腹膜透析患者血浆adiponectin水平较正常对照组明显升高(P=0.049),较血液透析组明显升高(P=0.007)[(2.335±1.673)mg/LVs(1.442±0.632)mg/LVs(1.256±0.613)mg/L],而血液透析组血浆ADPN水平较正常对照组差异无显著性(P>0.05);②腹膜透析患者体重指数(BMI)≥25kg/m2较BMI<25kg/m2其ADPN水平明显升高(P<0.01),SGA评分营养良好者较营养不良ADPN水平明显升高(P<0.01),多元回归分析ADPN的独立影响因素是BMI,回归方程为Y(ADPN)=-3.451+0.611X1(BMI);③Pearson相关分析表明血液透析患者ADPN水平与年龄负相关(r=-0.478,P=0.01),与透析充分性Kt/V正相关(r=0.518,P=0.016),与SGA评分负相关,但多元线性回归分析表明年龄﹑Kt/V是血液透析患者血浆ADPN水平的独立影响因素,其回归方程为Y(ADPN)=2.263-0.556X1(年龄)+0.403X2(Kt/V);④所有透析患者的血浆ADPN水平与超敏C反应蛋白,IL-6和TNF-α无显著相关,与血清甘油三酯,总胆固醇水平无显著相关。结论肾功能与透析治疗对血浆ADPN的水平调节只起很小的作用,腹膜透析患者的ADPN与体重指数正相关,血液透析患者的ADPN与年龄负相关,与透析充分性正相关。所有透析患者的营养水平与ADPN正相关,但不是独立影响因素,ADPN与透析患者炎症反应和血脂水平亦无明确相关性。

Objective To observe plasma Adiponectin （ADPN） levels in maintenance hemodialysis and peritoneal dialysis patients and explore the related factors. Methods The subjects consist of 20 normal control, 30 hemodialysis patients and 30 peritoneal dialysis patients. Plasma ADPN levels were measured by ELISA method. The serum IL-6, TNF-α, highsensitivity C-reactive protein （hs-CRP）, pre-albumin, transferrin, triglyceride, total cholesterol levels of all dialysis patients were also measured. Patients Kt/V were calculated and patients nutrition state were assessed by subject global assessment（SGA）. Results （1） Plasma Adiponeetin levels in the peritoneal dialysis group[ （2. 335± 1.673） mg/L]were signifieantly higher than those of normal control group [（1. 442± 0. 632）mg/L], and hemodialysis group [（1.256±0. 613）mg/L], but there were no significant difference between the hemodialysis group and the normal control group （2）Plasma ADPN levels were significantly higher in the peritoneal dialysis patients with body mass index（BMI）≥25kg/m^2 and with normal nutrition state than those of patients with BMI 〈 25kg/ m^2 and with malnutrition. ADPN was significantly positively correlated with BMI by multiple regression analysis and the regression equation was Y（ADPN）=0.611X1（BMI）-3.451;（3）Plasma ADPN levels were negatively correlated with age and SGA scores, positively correlated with Kt/V in the hemodialysis patients, but the independent factors of ADPN levels were age and Kt/V by multiple regression analysis and the regression equation was y（ADPN）= 2.263-0.556X1（age）±0. 403X2（Kt/V）; （4）ADPN levels in all dialysis patients were not significantly correlated with hs-CRP, IL-6, TNFα,triglyceride and total cholesterol. Conclusion Adiponectin was only weakly affected By renal function and dialysis replacement treatment. It was influenced by BMI in the peritoneal dialysis patients while by Kt/V and age in the hemodialysis patients. ADPN was positively correlated with nutrition status but it was not an independent factor. Moreover, ADPN was not significantly correlated with inflammation and serum lipids.