腹膜透析患者腹透液中脂联素、瘦素水平的影响因素研究

Study on factors affecting the adiponectin and leptin dialysate concentrations in CAPD patients

目的探讨影响腹透液中脂联素(ADPN)和瘦素(LEP)浓度的因素。方法选择稳定腹膜透析3个月以上患者41例,收集临床资料,采用ELISA法测定患者血清和腹透液中ADPN、LEP、转化生长因子-β1(TGF-β1)、胰岛素样生长因子-1(IGF-1)浓度,评估腹透充分性(尿素清楚指数KT/V)和腹膜溶质转运率(PTR),分别根据有无残余肾功能(RRF)、PTR高低进行分组比较,并进行相关性分析和多元线性回归分析。结果 RRF和PTR对腹透患者血清、腹透液ADPN、LEP浓度无影响。多元线性回归分析显示持续性非卧床腹膜透析患者腹透液TGF-β1(R2 change=0.483,P<0.001)、腹膜KT/V(R2 change=0.094,P<0.001)和ADPN独立相关,可以解释57.7%的变异。血清超敏C反应蛋白、IGF-1与腹透液中LEP水平独立相关。结论腹透液中ADPN浓度可能和腹膜慢性炎症反应、腹膜透析效率有关,而腹透液LEP水平可能与炎症、营养不良有关。

Objective The aim of our study was to evaluate factors affect the dialysate concentrations of adiponectin and leptin in CAPD patients. Methods Forty-one patients received CAPD therapy more than three months were recruited in this study. Their clinical and laboratory data were collected, serum and dialysate concentrations of adiponectin, leptin, TGF-β1 and IGF-1 were estimate by ELISA. All data were analyzed with SPSS13.0 software. Patients grouped according to absence or presence of RRF, high or low PTR. Correlation analysis and multivariate forward stepwise linear regression analysis were performed. Results There was no difference in serum and effluent adipokine levels was observed between patients grouped by RRF or PTR. Multivariate forward stepwise linear regression analysis shows effluent TGF-β1 concentration （R2 change=0.483, P〈0.001 ） and peritoneal solute clearance （Kpt/V （urea）） （R2 change=0.094,P〈0.001） were independently associated with effluent ADPN concentration and explained the 57.7% of variance. However, hsCRP and IGF-1 were independently associated with effluent LEP concentration. Conclusion The peritoneal chronic inflammation and dialysis adequacy may affact the dialysate concentrations of adiponectin. Malnutrition and inflammation might be related to the dialysate concentrations of leptin.