维持性腹膜透析患者血清脂联素改变及与心脑血管事件的相关研究

Changes of serum adiponectin and its correlation with cardio-cerebrovascular events in patients with maintenance peritoneal dialysis

目的:探讨维持性腹膜透析(maintenance peritoneal dialysis,MPD)患者血清脂联素(adiponectin,ADPN)改变及其与心脑血管事件的关联。方法:选择128例MPD患者为MPD组,同时取30例常规体检对象为对照组,检测血常规、电解质、肝功能、肾功能、血脂以及CRP等指标,测定两组血清ADPN水平,并比较不同原发病因的MPD患者之间ADPN水平。将MPD患者以血清ADPN中位数为截点分为低ADPN组与高ADPN组,在平均12个月的随访期间分别对两组新发心源性、脑源性疾病情况进行调查统计,采用单因素Logistic回归探讨血清ADPN与心源性、脑源性疾病情况之间的关系,同时分析影响血清ADPN水平变化的相关因素。结果:MPD组与对照组之间在性别、年龄、BMI、高密度脂蛋白(high-density lipoprotein,HDL)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、血钙、血钾等方面差异均无统计学意义(均P>0.05);相比于对照组,MPD组血红蛋白(hemoglobin,Hb)显著降低,而血肌酐、尿素、尿酸、CRP、血磷、ADPN均显著升高(均P<0.01);MPD各原发病分组之间血清ADPN水平差异无统计学意义(P>0.05)。MPD患者低ADPN组和高ADPN组间性别、年龄、血肌酐、尿素、尿酸、Hb、TC、血钙、血磷、血钾等差异均无统计学意义(均P>0.05);低ADPN组BMI、CRP、TG、透析龄高于高ADPN组,而HDL低于高ADPN组(P<0.05)。随访期间低ADPN组并发心源性、脑源性疾病的发病率较高ADPN组相比明显升高(26.56%vs 12.50%,χ^(2)=4.026,P<0.05),单因素Logistic回归分析显示血清高ADPN可作为MPD患者发生心源性、脑源性疾病的保护因素,其并发心脑血管事件可能性显著小于低ADPN患者(P<0.05)。相关分析显示,MPD患者血清ADPN与年龄、TC、Hb、血钾、血钙、血磷无相关性,而与BMI、TG、CRP、透析龄呈负相关,与HDL呈正相关。结论:MPD患者血清ADPN水平较正常人显著增高,其中低ADPN患者并发心源性、脑源性疾病的风险较高,值得临床关注和重视。

Objective:To investigate the changes of serum adiponectin(ADPN)and its relationship with cardio-cerebrovascular events in patients with maintenance peritoneal dialysis(MPD).Methods:A total of 128 patients with MPD were selected as the MPD group,and 30 normal subjects as the control group.The routine blood test,electrolytes,liver function,renal function,blood lipids and CRP were measured.The serum ADPN levels of the two groups were detected,and the ADPN levels of MPD patients with different etiologies were compared.MPD patients were divided into low and high ADPN subgroups by the median serum ADPN level as the cut-off point.During the average 12-month follow-up period,the newly developed cardio-cerebrovascular events in the two subgroups were investigated.The correlation between serum ADPN and cardio-cerebrovascular events was analyzed by univariate logistic regression,and the related factors affecting the change of serum ADPN level were analyzed.Results:There was no significant difference in gender,age,BMI,high-density lipoprotein(HDL),total cholesterol(TC),triglyceride(TG),blood calcium and potassium between MPD group and control group(P>0.05),and compared with the control group,hemoglobin(Hb)in MPD group decreased significantly,while serum creatinine,urea,uric acid,CRP,blood phosphorus and ADPN increased significantly(P<0.01).However,there was no significant difference in serum ADPN level between different etiological groups(P>0.05).There was no significant difference in gender,age,serum creatinine,urea,uric acid,Hb,TC,blood calcium,phosphorus and potassium between low ADPN and high ADPN subgroups(P>0.05).The BMI,CRP,TG and dialysis course in low ADPN subgroup were higher than those in high ADPN subgroup,while HDL was lower than that in high ADPN subgroup(P<0.05).During the follow-up period,the proportion of cardio-cerebrovascular events in low ADPN subgroup was significantly higher than that in high ADPN subgroup(26.56%vs 12.50%,χ2=4.026,P<0.05).Univariate Logistic regression analysis showed that high ADPN level could be as a protective factor for cardio-cerebrovascular events in patients with MPD,and the possibility of cardio-cerebrovascular events was significantly lower than that in patients with low ADPN(P<0.05).Correlation analysis showed that serum ADPN level was not correlated with age,TC,Hb,blood potassium,calcium and phosphorus,but negatively correlated with BMI,TG,CRP and dialysis course,and positively correlated with HDL.Conclusion:The serum ADPN levels in MPD patients were significantly higher than those in normal individuals,and those MPD patients with low ADPN had a higher risk of developing cardiovascular and cerebrovascular diseases,which deserves clinical more attention.