Association of vascular calcification,fetuin A,C - reaction protein and the influence on cardiovascular events in peritoneal dialysis patients

ObjectiveTo investigate the association of vascular calcification, fetuin A and C- reaction protein (CRP), and explore the influence on cardiovascular events. MethodsSixty peritoneal dialysis (PD) patients were enrolled in this study. Carotid intima-media thickness (cIMT), fetuin A and CRP, along with the other serum related parameters were detected to find out their influence on vascular calcification in PD patients. The relationship between cIMT, fetuin A, CPR and cardiovascular events was analyzed in PD patients with 18 months followed-up. ResultsOf the 60 PD patients, carotid intima-media thickness (cIMT) was increased in 38 patients(63.3%). Compared with the non-increased cIMT patients, serum fetuin A concentration was significantly decreased(P＜0.05), CRP(P＜0.01) and calcium × phosphate products(P＜0.05) were significantly increased in the high - increased cIMT group. Compared with the low - increased cIMT patients, fetuin A concentration was obviously lower(P＜0.05) and calcium×phosphate products were obviously higher(P＜0.05) in the high- increased cIMT group. Linear regression analysis discovered an obvious negative correlation between CRP and fetuin A(R 2＝0.629,F ＝47.522, P＜0.01) , as well as fetuin A and calcium×phosphate products (R 2＝0.299, F ＝11.948, P＝0.002). Multiple regression analysis indicated that fetuin A was independently negatively correlated with cIMT(B ＝-0.019,t ＝-6.042, P＜0.01). At 18 months, there were 36 newly - happened cardiovascular events and among which 6 cases died. Logistic regression analysis found that increased cIMT was risk factor to cardiovascular events in PD patients(OR ＝3.691， 95%CI 1.467-9.258，P＝0.006). ConclusionDecreased fetuin A and increased calcium×phosphate products deteriorate carotid calcification in PD patients. Micro-inflammation of PD patients represented by high CRP levels may increase calcium×phosphate products by depressing the fetuin A level, and in the end will stimulate carotid calcification. Increased cIMT is a risk factor for cardiovascular events.     

Changes of serum leptin levels and the influential factors in peritoneal dialysis patients

Objective To investigate the changes of serum leptin levels and the influential factors in maintenance peritoneal dialysis patients. Methods Seventy-six peritoneal dialysis patients were chosen at the time before, and 3 months, 6 months, 12 months, 18 months and 24 months after they began the peritoneal dialysis therapy, to examine body mass index (BMI), triceps skinfold thickness (TSF), abdominal circumference, homeostasis model assessment of insulin resistance (HOMA-IR), the plasma lipid profile, and leptin in the same situation. Results For 24 months, these patients showed higher serum leptin level than the values before commencing peritoneal dialysis treatment (P＜0.01). The level of leptin was positively correlated with the BMI(r＝0.412, P＜0.01), TSF(r＝0.308, P＜0.01), abdominal circumference(r＝0.284, P＜0.01), HOMA-IR(r＝0.184, P＜0.01) and TG(r＝0.288, P＜0.01), negatively corelated with the high-density lipoprotein cholesterol(HDL-C)(r＝-0.285, P＜0.01). Multiple logistic regression analysis showed that BMI (β＝0.339, P＜0.01), TG(β＝0.157, P＜0.01) and HDL (β＝-0.126, P＜0.05)were significant predictive factors for the changes of serum leptin levels. Conclusion Leptin maybe involve in the occurrence and the development of cardiovascular events like other metabolic parameters in peritoneal dialysis therapy.     

Relationship between islet α - cell function and glomerular filtration rate in type 2 diabetic patients

Objective To analyze the islet α-cell function in type 2 diabetic patients with different levels of glomerular filtration rate(eGFR). Methods Three hundred and eighty-eight cases of type 2 diabetic patients were classified into four groups according to eGFR: glomerular hyperfiltration group, normal renal function group, mild renal dysfunction group and moderate-severe renal dysfunction group. Oral glucose tolerance test, insulin releasing test and glucagon releasing test were conducted to compare the changes of glucagon(GLA), insulin/glucagon ratio（INS/GLA）, glucose/glucagon ratio（GLU/GLA）, the area under the curve of glucagon(AUCGLA) among the groups and correlation analysis were performed among glucagon and glomerular filtration rate and other indicators. Results With the decline of eGFR, the change curve of glucagon level was“J”shaped; the level of fasting glucagon in each group were（82.21±15.06）ng/L,（74.25±15.34）ng/L,（81.16±20.18）ng/L, （100.21 ± 24.73）ng/L, respectively. Compared with normal renal function group, GLA, AUCGLA in glomerular hyperfiltration group and renal dysfunction group increased significantly(P＜0.05), GLU/GLA, INS/GLA decreased significantly. Pearson correlation coefficient analysis showed that fasting glucagon had a negative correlation with eGFR（r＝-0.360,P＜0.01）, plasma albumin (ALB)（r＝ -0.170,P＜0.01）and high - density lipoprotein cholesterol (HDL - C)（r＝-0.128,P＜0.05）, had a positive correlation with fasting venous blood glucose (FPG)（r＝0.339,P＜0.01）, postprandial 2 hours venous blood glucose(2hPG)（r＝0.443,P＜0.01）, the area under the curve of blood glucose (AUCG)（r＝0.475,P＜0.01）, duration（r＝0.257,P＜0.01）and glycosylated hemoglobin(HbA1c) （r＝0.202,P＜0.01）. Multiple stepwise regression analysis showed that fasting glucagon was negatively correlated with eGFR（β ＝-0.290,t＝-5.393,P＜0.01） and HDL - C（β ＝-0.157,t＝ -3.026,P＜0.01）. Conclusions Glucagon level is influenced by eGFR in type 2 diabetic patients. Glucagon in patients with glomerular hyperfiltration or renal dysfunction is significantly higher than those with normal renal function. The inhibition effect of blood glucose and insulin to glucagon are both weakened.     

Association between osteopontin and intact parathyroid hormone in maintenance hemodialysis patients

Objective To explore possible associations between osteopontin(OPN) and intact parathyroid hormone(iPTH), to investigate effects of them on the progression of carotid artery calcification in patients receiving long-term hemodialysis. Methods Forty-eight maintenance hemodialysis (MHD) patients and 28 age- and sex-matched healthy volunteers were recruited. The concentration of OPN in peripheral blood was determined by enzyme linked immunosorbent assay (ELISA). Levels of iPTH and presence of plaques in the common carotid arteries were also measured. The demographics were recorded. Results Compared with controls, levels of OPN[(137.4±80.8)ng/L vs (31.6±6.7) ng/L, P＜0.01] and iPTH[(456.4±326.4) ng/L vs (66.9±19.3)ng/L, P＜0.01] were higher inMHD patients before hemodialysis, the numbers of calcific plaques in the common carotid arteries were increased in MHD patients (P＜0.01). There was a positive correlation between pre-dialysis OPN levels and iPTH levels (r＝0.620, P＜0.01) in MHD patients. Higher levels of OPN and iPTH correlated with greater numbers of calcific plaques in the common carotid arteries after division into three subgroups of MHD patients based on calcific plaques. In multiple linear regression analysis, the correlation between the pre-dialysis OPN and iPTH levels remained the same even if adjusting for confounding effects[β＝0.468, 95%CI (0.036, 0.195), t＝2.936, P＝0.005]. Conclusion OPN level is positively correlated with iPTH level in hemodialysis patients, which suggesting that both of them play important roles in the progression of carotid artery calcification.     

Treatment of Acute Rejection

Abstract

Background: Cardiovascular disease (CVD) is the most important cause of morbidity and mortality in patients with end stage renal disease (ESRD). Apelin expressed in endothelial and other tissues including brain and kidney is an adipocytokine defined recently and is emerging an important mediator of cardiovascular homeostasis. The aim of this study was to test whether apelin levels might be associated with carotid artery atherosclerosis and left ventricular mass index (LVMI) in peritoneal dialysis patients. Patients and methods: Fifty peritoneal dialysis patients (25 female, mean age 41.4?±?11.9 years, mean dialysis vintage 65.0?±?35.4 months) and 18 healthy individuals (9 female, mean age 41.7?±?6.8 years) were included in this cross-sectional study. Serum apelin 12 levels, echocardiographic findings and carotid intima media thickness (CIMT) were recorded as well as clinical and laboratory data. Results: There were no differences between the patient and the control groups with regard to demographic characteristics. In patient group, LVMI, CIMT, CRP and apelin levels were elevated compared to control group. However there was no association between apelin, LVMI and CIMT. There was a positive correlation between apelin and CRP, which was not statistically significant. When patients were divided into two groups according to the mean serum apelin levels, LVMI, CIMT and CRP were higher in the high apelin group but this difference did not reach statistical significance. Conclusion: We observed an increased inflammation and CVD risk in peritoneal dialysis patients. However, serum apelin levels seem not to be associated with cardiovascular risk in this group of patients.     

Association between endothelial dysfunction and arterial stiffness in continuous ambulatory peritoneal dialysis patients

Objective To investigate the association between endothelial dysfunction and arterial stiffness in continuous ambulatory peritoneal dialysis （CAPD） patients. Methods Ninety-four stable CAPD patients from a single center were enrolled in this cross-sectional study. Ultrasound evaluation was conducted on brachial artery to estimate endothelial-dependent flow-mediated dilation (FMD). Automatice pulse wave velocity (PWV) measuring system was applied to examine the carotid-femoral PWV. Blood pressure and biochemical parameters were detected. Pearson's correlation and Stepwise multiple regression analysis were performed to explore the relationship between FMD and PWV. Results PWV was significantly higher in patients with diabetes as compared to those without diabetes[(13.25±1.66) m/s vs (11.24±1.92) m/s, P＜0.01]. Furthermore, PWV was positively correlated with age(r＝0.319, P＝0.002), SBP (r＝0.289, P＝0.005) and C-reactive protein (r＝0.211, P＝0.041), was negatively correlated with albumin (r＝-0.429, P＝0.001) and FMD (r＝-0.466, P＝0.001). In multivariate regression analysis, diabetes mellitus, albumin, FMD, age and SBP were independently associated with PWV after adjustment. Conclusion Endothelial dysfunction is associated with greater arterial stiffness in CAPD patients.     

Glycemic control and survival in peritoneal dialysis patients with diabetes mellitus

Purpose

The optimal target for glycated hemoglobin (HbA1c) has not been well defined in peritoneal dialysis (PD) patients with diabetes mellitus.

Methods

The objective of our study was to examine the predictive value of predialysis and time-averaged follow-up HbA1c values on technique and patient survival in diabetic PD patients treated in the Toronto General Hospital Home Peritoneal Dialysis Unit, between January 1, 2003 and December 31, 2008 with a median follow-up period of 30?±?23?months.

Results

Ninety-one patients (mean age 64?±?13 years-old) were included in this retrospective study. Patients were followed between 3 and 91?months (mean duration 30?±?23?months). During this period, 40 patients died. We found no statistically significant correlation between baseline predialysis HbA1c values and technique and patient survival. Time-averaged follow-up HbA1c in increments <6.5 %, 6.5?C8 %, and >8?% showed no significant survival difference among groups.

Conclusions

There was no significant correlation of baseline and time-averaged follow-up HbA1c values with patient and PD technique survival.     

腹膜厚度与腹膜溶质转运功能的相关性

目的 探讨腹膜透析患者腹膜厚度与基线溶质转运功能的关系,分析腹膜转运功能的影响因素.方法 入选2017年1月至2019年6月福建省龙岩市第二医院肾内科收治的非糖尿病终末期肾脏病(ESRD)患者为研究对象.腹膜透析置管术前用彩色超声仪测量患者壁层腹膜厚度.腹膜透析治疗后1个月行标准腹膜平衡试验(PET)检查,以4h腹透液的矫正肌酐与2h血清肌酐的比值(D/Pcr)作为基线溶质转运指标,并按照D/Pcr评估结果分为高/高平均转运(H)组(D/Pcr≥0.65)和低/低平均转运(L)组(D/Pcr< 0.65).比较两组患者临床资料、壁层腹膜厚度和腹膜透析相关指标的差异;二元Logistic回归法分析腹膜转运功能的影响因素.结果 共纳入70例非糖尿病ESRD患者,H组患者腹膜超滤量显著低于L组;腹膜内生肌酐清除率(Ccr)和腹膜厚度显著高于L组(均P<0.05).Pearson及Spearman相关性分析结果显示,腹膜透析患者壁层腹膜厚度与溶质转运指标D/Pcr(r=0.673)、腹膜内生肌酐清除率(Ccr,r=0.261)呈正相关,与腹膜透析超滤量呈负相关(r=-0.365,均P<0.05).偏相关分析结果显示,腹膜厚度与溶质转运指标D/Pcr (r=0.539)、腹膜Ccr(r=0.338)呈正相关(均P<0.05).二元Logistic回归分析结果显示,腹膜增厚是腹膜转运功能的危险因素(OR=1.175,95%CI1.009~ 1.369,P=0.038).结论 非糖尿病腹膜透析患者壁层腹膜厚度与基线溶质转运指标呈正相关,腹膜增厚是影响腹膜转运功能的危险因素.     

血清淀粉样蛋白A与2型糖尿病肾病患者颈动脉内膜中层厚度的相关性研究

目的 探讨血清淀粉样蛋白A （SAA）在2型糖尿病肾病（DN）的改变及与颈动脉内膜中层厚度（CIMT）的相关性.方法 根据24h尿微量白蛋白排泄率（UAER）将75例2型糖尿病患者分为2组：单纯糖尿病组（SDM组,39例）和早期糖尿病肾病组（EDA组,36例）,同时以35例健康人作为正常对照组（NC组）.用ELISA法检测各组空腹血清SAA浓度,同时测定各组的肌酐（Cr）、尿素氮（BUN）、血糖血脂、胰岛素抵抗指数（HOMA-IR）、超敏C反应蛋白（Hs-CRP）、CIMT等指标,并分析血清SAA与CIMT及其他指标的相关性.结果 EDA组和SDM组SAA水平明显高于NC组[分别为（7.98±0.63 vs.6.09 ±0.72vs.2.75 ±0.30 mg/L）,P＜0.05或P＜0.01];EDA组、SDM组和NC组CIMT值组间比较均有统计学差异[分别为（1.07±0.13vs.0.86 ±0.22 vs.0.72±0.13mm）,P＜0.05或P＜0.01].SAA水平与Hs-CRP、IL-6、FBG、HOMA-IR、CIMT、颈动脉斑块数量和UAER成明显正相关,与HDL-C成明显负相关（P＜0.05或P ＜0.01）.EDN组双侧斑块数量≥2个的患者SAA水平显著高于斑块只有1个或无斑块的患者（P＜0.01）,与斑块厚度呈正相关（r=0.409,P ＜0.05）.UAER、HOMA-IR、CIMT和Hs-CRP是影响DN患者SAA水平的独立影响因素.结论 联合检测SAA和CIMT可推断SAA对动脉粥样硬化的影响,全面的评价早期糖尿病肾损害,提示临床应早期干预血浆SAA水平防治DN及其他微血管和大血管病变.     

The usefulness of micro- and macrochromatographic determinations of glycohemoglobin in diabetic patients with nephropathy

Determination of glycohemoglobin in blood (HbA1) represents an established measure of glycemic control in diabetic patients. In patients with uremia, however, the determination can be subject to pitfalls which may limit its reliability. In order to evaluate the clinical usefulness of HbA1 determinations in diabetic patients with nephropathy, concentrations of HbA1 and its subfractions HbA1c and HbA1a+b were measured by micro- and macrocolumn chromatography in 58 diabetic and 80 non-diabetic patients with impaired renal function. Fifteen diabetic patients without nephropathy and 15 healthy subjects served as controls. The concentrations of HbA1 and its subfractions were significantly higher in non-diabetic patients with nephropathy than in healthy controls. A positive correlation was seen between HbA1 and plasma glucose concentrations in all subjects, and between HbA1 and serum urea and creatinine concentrations in the non-diabetic subjects. When measured repeatedly in the same patient there was a positive correlation between HbA1 and plasma glucose concentrations in diabetic patients with azotemia. There was no change in HbA1 concentrations measured immediately before and after hemo- or peritoneal dialysis. The increase of chromatographically determined HbA1 concentrations in azotemic patients is most likely due to the joint action of carbamylation of hemoglobin with urea derived cyanate and deterioration of glycemic control induced by azotemia. Despite these problems, chromatographically determined HbA1 is still a clinically useful measure of glycemic control in diabetic patients with nephropathy. This presumes repeated measurements in the same patient and the use of appropriate reference levels which consider the degree of renal impairment.     

Carotid artery intima-media thickness correlates with oxidative stress in chronic haemodialysis patients with accelerated atherosclerosis.

BACKGROUND: Accelerated atherosclerosis is the major cause of mortality in patients on chronic haemodialysis (HD). Increased oxidative stress might be the major factor leading to high cardiovascular mortality rate in HD patients. The aim of our study was to clarify effects of uraemia and dialysis on oxidative stress parameters and explore the relation between oxidative stress markers and carotid artery intima-media thickness (CIMT) as an indicator of atherosclerosis. METHODS: Twenty chronic HD patients, 20 predialytic uraemic patients and 20 healthy subjects were included in the study. Serum thiobarbituric acid reactive substances (TBARS), protein carbonyl content (PCO) and nitrite/nitrate levels were determined as oxidative stress markers. Serum vitamin E, plasma sulfhydryl (P-SH), erythrocyte glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) activities were measured as antioxidants. CIMT was assessed by carotid artery ultrasonography. RESULTS: Both chronic HD and predialytic uraemic patients had enhanced oxidative stress indicated by higher levels of nitrite/nitrate, TBARS and PCO, and lower levels of P-SH, SOD, CAT and GPx compared to controls. HD patients had significantly higher CIMT and nitrite/nitrate while significantly lower P-SH,vitamin E, SOD, CAT and GPx compared to predialytic uraemic patients. There was a significant positive correlation between CIMT and TBARS (r = 0.38, P = 0.003) and nitrite/nitrate levels (r = 0.41, P = 0.001), while there was a significant negative correlation between CIMT and SOD (r = -0.35, P = 0.01), CAT (r = -0.65, P < 0.001) and P-SH levels (r = -0.50, P < 0.001). A linear regression analysis showed that TBARS were still significantly and positively correlated with CIMT (P = 0.001), while CAT and P-SH were significantly and negatively correlated with CIMT (P = 0.002 and P = 0.048, respectively). CONCLUSIONS: HD exacerbates oxidative stress and disturbances in antioxidant enzymes in uraemic patients. We propose that serum TBARS and nitrite/nitrate can be used as positive determinants, while erythrocyte SOD, CAT and P-SH may be used as negative determinants of atherosclerosis assessed by CIMT in uraemic and HD patients.     

Subclinical atherosclerosis is increased in type 2 diabetic patients with microalbuminuria evaluated by intima-media thickness and pulse wave velocity

BACKGROUND: Microalbuminuria appears to be a risk marker for atherosclerosis. However, little is known about the direct association between microalbuminuria and vascular wall properties. METHODS: Subjects were 306 type 2 diabetic patients with normoalbuminuria (N= 200) and microalbuminuria (N= 106). Those who had macroalbuminuria, atherosclerotic vascular disease, and/or ankle brachial index being less than 0.9 were not included. Brachial-ankle pulse wave velocity (PWV) was measured by automatic oscillometric method. Intima-media thickness (IMT) of the common carotid artery was measured using high-resolution B-mode ultrasonography and a computerized image-analyzing system. RESULTS: Average IMT, maximum IMT, and PWV were significantly higher in patients with microalbuminuria than in patients with normoalbuminuria. Both average and maximum IMT increased significantly as albuminuria increased in the microalbuminuric range. Average IMT and maximum IMT correlated significantly with PWV (P < 0.0001), although some patients exhibited increased levels of only PWV or IMT. By a multiple linear regression, age and albuminuria were independent predictors of IMT and PWV. Waist circumference was an independent predictor of IMT. Hypertension and hemoglobin A(1c) (HbA(1c)) were independent predictors of PWV. After adjustment for conventional cardiovascular risk factors including age, sex, waist circumference, HbA(1c), hypertension, hyperlipidemia, and smoking, albuminuria revealed a significant association with average IMT, maximum IMT, and PWV (P < 0.05, P < 0.0001, and P < 0.05, respectively). CONCLUSION: A slight elevation of albuminuria is a significant determinant of IMT and PWV independent of conventional cardiovascular risk factors in type 2 diabetic patients with no clinical nephropathy or any vascular diseases. This significant association might point to a link in the pathogenesis of atherosclerosis and diabetic nephropathy.     

Prognostic comparison of patients starting peritoneal dialysis within two weeks and more than two weeks after catheter implantation

Objective To compare the outcomes of patients starting peritoneal dialysis (PD) within two weeks and more than two weeks after catheter implantation. Methods All the patients undergoing Tenckhoff catheter implantation and initiating PD in Renji Hospital from January 2001 to December 2010 were enrolled in the study. Patients started PD within 2 weeks after catheter insertion were defined as urgent group, and those started PD 2 weeks later were defined as planned group. Kaplan?Meier curves and Log-rank tests were used to compare outcomes between two groups. Results Among 657 patients in this study, median break-in period was 6 days of 469 (71.4%) patients in urgent group and 26 days of 188 (28.6%) patients in planned group. Compared to planned group, patients of urgent group were younger [(52.6±17.3) vs (56.1±15.3) year, P＝0.017], had less eGFR [(5.36±2.03) vs (6.50±2.50) ml•min-1•(1.73 m2）-1, P＜0.01], lower serum albumin [(34.0±5.7) vs (36.2±5.9) g/L, P＜0.01] and hemoglobin [(76.9±18.8) vs (80.8±17.9) g/L, P＝0.018], and higher phosphate [(2.19±0.67) vs (1.98±0.52) mmol/L, P＜0.01]. Urgent group presented more catheter dysfunctions needed to transfer to hemodialysis (2.1% vs 0%, P＝0.044). The 1-, 2-, 3- and 5-year technique survival rates of urgent and planned group were 94% vs 98%, 92% vs 94%, 90% vs 92% and 86% vs 85% respectively. There was no significant difference in technique survival (Log-rank＝1.536, P＝0.22) and peritonitis?free survival (Log-rank＝0.035, P＝0.85) between two groups. The 1-, 2-, 3- and 5-year patient survival rates of urgent and planned group were 90% vs 95%, 81% vs 90%, 74% vs 79% and 67% vs 74% respectively, and no significant difference was found (Log-rank＝2.364, P＝0.12). Conclusions Although patients needing urgent initial PD have poorer residual renal function and nutritional condition compared to those of planned initial PD, their outcomes are similar. Peritoneal dialysis may be a feasible and safe dialysis modality for patients who need urgent start.     

Is serum sclerostin a marker of atherosclerosis in patients with chronic kidney disease–mineral and bone disorder?

Purpose

The complexity of chronic kidney disease–mineral and bone disorder (CKD–MBD) led to many preclinical and clinical trials. The role of sclerostin in renal pathophysiology remained unresolved, and question whether sclerostin is related to cardiovascular (CV) outcome in patients with CKD is still open. Our aim was to evaluate the possible association between serum sclerostin levels and carotid intima-media thickness (CIMT) in CV pathophysiology through various CKD stages.

Methods

Eighty-eight patients in various CKD stages were involved in this analysis. CKD-EPI (Chronic kidney disease Epidemiology Collaboration Equation) was used to estimate glomerular filtration rate (eGFR). CKD–MBD parameters were determined in patients’ serum after an overnight fasting. Early atherosclerosis was assessed by ultrasound measurement of CIMT. In order to assess the association between serum sclerostin with other CKD–MBD parameters and CIMT, correlation and regression analyses were performed.

Results

Mean age was 62.84?±?11.37 years and 56% were female. Mean values of serum sclerostin were 1.67?±?0.44 ng/ml. Negative correlation was noticed with serum calcium and phosphate product (CaxP), alkaline phosphatase (ALP), intact parathyroid hormone (iPTH), serum creatinine, and HbA1c level. There was no association with FGF23, CIMT, and carotid atherosclerotic plaque occurence. Serum levels of sclerostin were significantly higher in female patients compared to males (p?<?0.001).

Conclusion

Advanced CKD showed a trend of declining sclerostin levels and significantly higher CIMT levels. Serum sclerostin was not associated with CIMT. More studies are needed in order to reveal the exact role of sclerostin in the complexity of CKD–MBD pathophysiological mechanism.

     

维持性血液透析患者血清胱抑素C与细胞因子及颈动脉病变的关系

目的 研究维持性血液透析（MHD）患者的血清胱抑素C（半胱氨酸蛋白酶抑制剂,CysC）水平的变化及其与细胞因子及颈动脉病变的关系。 方法 选择透析龄超过6个月的MHD患者110例（MHD组）和健康对照组60例为对象。用免疫透射比浊法检测CysC;超声检查颈动脉病变的程度;检测高敏C反应蛋白（hsCRP）、总同型半胱氨酸（tHcy）、血清白介素1β（IL-1β）、IL-6、肿瘤坏死因子α（TNF-α）水平。分析CysC水平与细胞因子及颈动脉病变的关系。 结果 MHD组血清CysC水平为（6.19±0.95） mg/L,显著高于健康对照组的（0.76±0.21） mg/L（P < 0.01）。MHD组hsCRP、tHcy、IL-1β、IL-6、TNF-α水平均显著高于健康对照组（P < 0.05或<0.01）。MHD组患者颈动脉内膜中层厚度（IMT）及斑块形成、颈动脉硬化的患病率均显著高于健康对照组（P < 0.05或P < 0.01）。直线相关分析显示,MHD组血CysC水平与hsCRP、tHcy、IL-1β、IL-6、TNF-α、IMT及斑块形成、颈动脉硬化的患病率呈正相关;与透析龄、收缩压、iPTH亦呈正相关（P < 0.05或P < 0.01）。多因素逐步回归分析显示,CysC、hsCRP、tHcy和年龄是MHD患者颈动脉病变的危险因素。 结论 血液透析不能有效清除CysC等大分子物质,随着透析龄的增加,MHD患者血清CysC水平逐渐升高。CysC与hsCRP等微炎性反应指标及tHcy、颈动脉病变呈正相关,血清CysC水平升高可能是MHD患者并发动脉粥样硬化的危险因素之一。     

Is adiponectin a marker of preclinical atherosclerosis in kidney transplantation?

Cañas L, Bayés B, Granada ML, Ibernon M, Porrini E, Benítez R, Díaz JM, Lauzurica R, Moreso F, Torres A, Lampreabe I, Serra A, Romero R. Is adiponectin a marker of preclinical atherosclerosis in kidney transplantation?
Clin Transplant 2011 DOI: 10.1111/j.1399‐0012.2011.01490.x.
© 2011 John Wiley & Sons A/S. Abstract: The aim of this study was to analyze the relationship between pre‐transplant adiponectin (pre‐ADP), abnormalities in glucose homeostasis (AGH) at three months post‐transplantation, and preclinical atherosclerosis in non‐diabetic patients prior to kidney transplantation (KT). Methods: We carried out a multicenter study in 157 non‐diabetic KT patients (66.5% men; age: 50 ± 13 yr). Pre‐ADP levels were analyzed using radioimmunoassay. Carotid ultrasound was performed to determine carotid intima‐media thickness (c‐IMT). Oral glucose tolerance test was carried out to classify patients according ADA criteria. Results: Of the patients, 52.8% had AGH. Median pre‐ADP was 19.5 (14–27) μg/mL. An inverse correlation was found between ADP and HOMA index (r = ?0.432; p < 0.001). Median c‐IMT was 0.6 (0.48–0.71) mm. Significant inverse correlation existed between ADP and c‐IMT on both sides (p < 0.05). Patients with c‐IMT >0.6 mm had more AGH (p = 0.012) and lower ADP levels (p = 0.02). We performed a logistic regression analysis using preclinical atherosclerosis (c‐IMT ≥0.6 mm) as dependent variable and sex, age, BMI, ADP, AGH, and HOMA index as independent variables of altered c‐IMT. Age, pre‐ADP, and AGH were independent risk factors for elevated c‐IMT. Conclusions: Patients with AGH have a greater presence of preclinical atherosclerosis. ADP has an inverse relationship with AGH and is an independent marker of preclinical atherosclerosis.     

Correlation between quality of life and mineral metabolism in maintenance hemodialysis patients

Objective With multi-center investigation, to assess the life quality of patients with maintained hemodialysis (MHD) in Liaoning Province and to explore the relationship among the mineral metabolism, the life quality of the patients with MHD, and the repeated hospitalization within the latest three years. Methods 1192 patients with hemodialysis (at least 3 months) from January to March in 2015 at ten blood purification centers in Liaoning Province were selected for the cross - sectional survey. The Kidney Health-related Quality of Life (HRQOL) version 1.3 was used to evaluate the MHD patients' life quality. The total length of hospitalization was divided into four groups: 0 days, 3 to 15 days, 16 to 30 days and above 30 days. Results When serum calcium value ranged from 2.1 to 2.5 mmol/L, kidney - disease component summary (KDCS), mental component summary (MCS), physical component summary (PCS) and SF-36+KDCS corresponded to a higher value (P＜0.05). When serum phosphorus value ranged from 1.13 to 1.78 mmol/L, KDCS and SF-36+KDCS corresponded to a higher value (P＜0.05). When the calcium phosphorus product value ranged from 40.68 to 49.94, MCS corresponded to a higher value (P＜0.05). KDCS showed a linear correlation with age (P＜0.001), dialysis age, serum calcium (less than or equal to 2.5 mmol/L) (P＜0.05); PCS showed a linear correlation with age (P＜0.001) and dialysis age (P＜0.05); SF-36+KDCS showed a linear correlation with age (P＜0.001), and serum calcium (less than or equal to 2.5 mmol/L) (P＜0.05), while age and dialysis age were negatively correlated. The hospitalization days showed a linear correlation with age, dialysis age (P＜0.001) and serum phosphorus, calcium phosphorus product value (P＜0.05), while dialysis age and calcium phosphorus product value were negatively correlated. Among different groups of total hospitalization days in three years, age, hemodialysis age, serum calcium, serum phosphorus, calcium-phosphorus product value and quality of life values were all statistically significant (P＜0.05). Conclusions The life quality of patients with MHD were correlated with serum calcium, phosphorus, calcium and phosphorus product value, iPTH, dialysis age and age, while age and dialysis age were of negative correlation. The total number of hospitalization days in 3 years was closely linearly correlated with age and dialysis age, significantly correlated with serum phosphorus, calcium and phosphorus product value, while dialysis age, calcium and phosphorus product value were in a negative correlation. The total number of hospitalization in 3 years was correlated with the patients' age, dialysis age, serum calcium, serum phosphorus, calcium and phosphorus product value and quality of life.     

尿胞外体1型辅助性T细胞/2型辅助性T细胞失衡与2型糖尿病肾病的相关性

目的 探讨2型糖尿病（DM）患者尿胞外体1型辅助性T细胞/2型辅助性T细胞（Th1/Th2）的变化与2型糖尿病肾病（DN）发生发展的相关性。 方法 选取120例2型糖尿病患者及健康对照组30例为对象,根据尿白蛋白肌酐比（UACR）,2型糖尿病患者分为糖尿病非肾病组（DM,40例,UACR<30 mg/gCr）、微量白蛋白尿组（DN1,50例,UACR≥30~300 mg/gCr）和临床白蛋白尿组（DN2,30例,UACR＞300 mg/gCr）。用特异性单克隆抗体提纯尿胞外体。用酶联免疫吸附法（ELISA）检测尿胞外体干扰素γ（IFN-γ）和白细胞介素4（IL-4）水平。用多元逐步回归方法分析尿胞外体IFN-γ/IL-4比值与糖化血红蛋白（HbA1c）、胆固醇（CH）、UACR、血肌酐（Scr）、尿素氮（BUN）相关性。 结果 DM、DN1、DN2组胞外体Th1/Th2水平显著高于健康对照组（0.8089±0.2458、0.8993±0.3515、0.8571±0.2470比 0.6198±0.1769,均P < 0.01）。DN1组胞外体Th1/Th2显著高于DM组（P < 0.01）。尿胞外体IFN-γ/IL-4与UACR（r = 0.213,P = 0.015）、BUN（r=0.292,P = 0.001）呈正相关。逐步多元回归分析显示, BUN是尿胞外体IFN-γ/IL-4的独立影响因素（β = 0.246,P = 0.006）。 结论 尿胞外体Th1/Th2漂移与2型糖尿病肾病密切相关,可能在糖尿病早期肾病发病过程中起重要的作用。     

The relationship of hepcidin level with renal anemia and micro ? inflammation status in peritoneal dialysis patients

ObjectiveTo observe the level of serum hepcidin and the relationship of hepcidin with renal anemia and micro - inflammation state in peritoneal dialysis(PD) patients. MethodsSerum hepcidin, interleukin-6(IL-6), soluble transferrin receptor (sTfR) and erythropoietin (EPO) were measured in 50 PD patients with anemia, 30 PD patients without anemia and 40 cases of normal control by ELISA. The indexes of blood routine examination, biochemistry and iron metabolism were also detected at the same time. ResultsThe level of hepcidin in PD patients was significantly higher than that in normal control[(103.65±43.6) μg/L vs (56.39±35.7) μg/L，P＜0.05]. Furthermore, the level of hepcidin in PD patients with anemia was higher than that in PD patients without anemia [(122.67±36.6) μg/L vs (83.65±26.4) μg/L，P＜0.05]. The results of correlation analysis showed that serum IL-6, sTfR, EPO and ferritin were positively correlated with hepcidin(R ＝0.821, 0.742, 0.711, 0.531，all P＜0.05 ), while creatinine clearance of residual kidney in 24 hours and hemoglobin were negatively correlated with hepcidin(R ＝-0.533, -0.685，all P＜0.05 ). ConclusionsThe higher level of hepcidin in PD patients is related with the residual renal function and the micro-inflammatory state. The higher level of hepcidin may induce the iron metabolism imbalance, and then influence the state of renal anemia. The adjustment of hepcidin may provide clinical research value of improving renal anemia and micro-inflammatory state in PD patients.