维持性血液透析患者血脂联素改变及与心脑血管事件的关系

The serum adiponectin level and its correlation with cardio-cerebrovascular events in maintenance hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis, MHD)患者血脂联素(ADPN)改变及与心脑血管事件的关联。方法收集血液净化中心行MHD的患者178例(MHD组),体检中心随机抽取健康体检者30例(对照组),比较两组一般临床资料及血ADPN水平;MHD患者据基础病分组,比较各组间血ADPN水平;以MHD组所测血ADPN的中位数为切点分为低ADPN组和高ADPN组,随访观察两组心脑血管事件的发生情况,用单因素logistic回归分析血ADPN与心脑血管事件间的关联,并做血ADPN水平变化的相关因素分析。结果 MHD组血ADPN明显高于对照组(P<0.01),但不同病因所致MHD患者各组间血ADPN水平差异无统计学意义(P>0.05)。随访期间低ADPN组患者发生心脑血管事件的比例明显高于高ADPN组(P<0.05),单因素logistic回归分析显示低ADPN增加MHD患者发生心脑血管事件的风险,是高ADPN组约2倍(95%CI 1.075～5.539,P=0.033)。Pearson相关分析显示,MHD患者血ADPN与体质指数、血红蛋白、C反应蛋白、抵抗素均呈负相关(r=-0.376、-0.228、-0.375、-0.302,P<0.01)。结论 MHD患者血ADPN水平明显增高,且低ADPN组患者发生心脑血管事件的风险明显高于高ADPN组;血ADPN可作为识别和预测MHD患者心脑血管事件的生物学指标,有潜在的临床应用价值。

Objective To study the serum adiponectin(ADPN) level and its correlation with cardio-cerebrovascular events in maintenance hemodialysis(MHD) patients. Methods The general clinical data and serum ADPN levels of 178 MHD patients and 30 healthy individuals were collected and compared. The patients were divided into different groups based on etiologies, and the ADPN levels were compared among them. The MHD patients were also divided into low ADPN group and high ADPN group according to the median of serum ADPN. The cardio-cerebrovascular events in patients were observed during follow-up, and the effect of serum ADPN level on cardio-cerebrovascular events in MHD patients was analyzed by univariate logistic regression analysis. Meanwhile, the correlations between ADPN with clinical and laboratory parameters were analyzed. Results There was no significant difference in the serum ADPN levels among the groups of MHD patients with different etiologies(P>0.05). Yet irrespective of origin or source, the ADPN level of MHD patients was significantly higher than that of the control group(P<0.01). Compared to high ADPN group, the incidence of cardio-cerebrovascular events was significantly raised in patients with low ADPN group(P<0.05). Univariate logistic regression analysis showed that low ADPN level increased the risk of cardio-cerebrovascular events in MHD patients, which is about two times as high as that of the high ADPN group(95%CI: 1.075-5.539, P=0.033). The serum ADPN level of MHD patients showed significantly negatively correlations with BMI, hemoglobin, CRP and resistin(r=-0.376,-0.228,-0.375 and-0.302, respectively, all P<0.01). Conclusions The serum ADPN level of MHD patients is significantly elevated. Compared to high ADPN group, the risk of cardio-cerebrovascular events rises in patients of low ADPN. Serum ADPN can be used as a biological indicator for identifying and predicting cardio-cerebrovascular events in MHD patients.