C-reactive protein elevation is associated with increased morbidity and mortality in elderly burned patients

BackgroundC-reactive protein (CRP) is an acute-phase protein produced in response to inflammation after traumatic injury. We posit that C-reactive protein (CRP) is reliable in predicting morbidity and mortality following severe burn. In this study, we explored the relationship between serum CRP values and clinical outcomes in the severely burned.MethodsUsing the Research Network within the TriNetX database, we queried de-identified burn patient data across the United States and enrolled 36,556 burn patients with reported CRP values from 2006 to 2020.ResultsCirculating CRP levels were elevated significantly in patients ≥60 years as well as in males and African Americans (p < 0.05). CRP levels reached the zenith on the first day after burn, and were highest when burn size reached 60% total body surface area (TBSA). After bisecting the data at 10 mg/L of CRP, we compared clinical findings between patient groups (n = 16,284/18,647 in high/low CRP levels). The risk of patient death doubled in the high CRP group from 4.687% to 9.313%, with higher incidences of sepsis, skin infection, and myocardial infarction (p < 0.05). Moreover, mortality increased from 0.9% to 1.926% in those younger than 20 years when comparing the low and high CRP groups, whereas mortality significantly increased from 8.84% to 15.818% in those ≥60 years old (p < 0.05). Both elderly and paediatric groups had significant increases in the diagnosis of sepsis-associated with increased CRP expression. However, incidences of skin infection, pneumonia, and acute kidney injury increased significantly only in the elderly group (p < 0.05).ConclusionElevated CRP expression is common in burn patients. The factor of age influenced the association of CRP expression to clinical outcomes.     

甲状腺素片补充治疗对慢性肾脏疾病患者甲状腺激素水平的影响研究

目的 探讨小剂量甲状腺素补充治疗对慢性肾脏疾病患者的甲状腺激素水平、营养不良及左心功能的影响.方法 湖南省人民医院2013年2月至2015年2月间收治的慢性肾脏疾病患者210例,A组为eGFR＜ 15mL ·(min·1.73m2)-1的患者(n=70),B组为15＜ eGFR＜30mL·(min·1.73m2)-1的患者(n=70),C组为30 ＜eGFR ＜60mL·(min·1.73m2)-1的未透析患者(n=70).选择同期本院体检的正常人群为正常对照组(D组,n =70).收集4组患者血液、生化临床资料,检测游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(freethyroxine,FT4)、促甲状腺激素(thyroid stimulating hormone,TSH)、C反应蛋白(C reactive protein,CRP)、左心室射血分数(left ventricular ejection fraction,LVEF)及左心室质量指数(Left ventricular mass index,LVMI),并计算主观综合性营养评估法(subjective global assessment of nutritional act,SGA)等指标.每组根据甲状腺激素水平分为正常组Ⅰ、异常组Ⅱ,观察各组间各指标差异,再给予异常组小剂量甲状腺激素干预后观察各项指标改变.结果 A、B、C组FT3均显著低于D组(P＜0.05),低T3综合征的发生率随eGFR下降而升高;正常组Ⅰ与异常组Ⅱ相比,ALB、CRP、SGA、LVEF、LVMI比较有显著差异(P＜0.05);异常组的FT3与eGFR、SGA、ALB、LVEF呈显著正相关(r=0.912,P＜0.001;r =0.721,P＜0.001;r =0.810,P＜0.001;r=0.903,P＜0.001);FT3与CRP、LVMI呈负相关(r=-0.981,P＜0.001;r=-0.442,P＜0.001);异常亚组给予小剂量甲状腺素治疗后FT3及LVEF较治疗前明显改善(P＜0.05),治疗后eGFR水平只有C2组患者有提高(P＜0.05).结论 甲状腺素水平下降与肾功能严重程度相关,以血清FT3水平降低为主;低水平FT3与营养、左心功能有显著相关性;予以小剂量的甲状腺激素治疗后的低T3及亚临床甲减者的左心收缩功能有提高,中度肾功能损伤的患者eGFR有提高.     

Relationship between thyroid function and carotid atherosclerosis in patients on maintenance hemodialysis

Objective To investigate the changes of thyroid function and carotid atherosclerosis in patients on maintenance hemodialysis (MHD). Methods A total of 110 stable MHD patients undergoing hemodialysis for at least three months were enrolled in the study. Serum free-T3 (FT3), free-T4 (FT4) and thyroid stimulating hormone (TSH) concentrations were measured by electrochemiluminescence．Plasma levels of homocysteine (Hcy) and C-reactive protein (CRP) were detected. Clinical data and biochemical indicators were collected. These patients were divided into thyroid dysfunction group and euthyroidism group. Prevalence of atherosclerosis was detected by carotid ultrasonography. The associations between the changes of thyroid function and carotid atherosclerosis were analyzed by Logistic regression model. Results Among these 110 patients, 42 (38.18%) patients had thyroid dysfunction. Hcy and CRP concentrations were significantly higher in thyroid dysfunction group than those in euthyroidism group (P＜0.05). The intima-media thickness, number of plague and arteriostenosis of carotid were higher in thyroid dysfunction group than those in euthyroidism group (P＜0.05). Multivariate logistic regression analysis showed that increased Hcy and CRP, decreased serum FT3 were independent risk factors for carotid atherosclerosis. Conclusions Thyroid dysfunction with low serum FT3 is frequently found in MHD patients. In MHD patients, FT3 is closely correlated to carotid atherosclerosis.     

糖尿病肾病中医证型与CRP指标关系探讨

目的：探讨糖尿病肾病（diabetic nephropathy,DN）患者中医证型分布特征与炎症指标C反应蛋白（CRP）的关系。方法：将2010年中国人民解放军总医院门诊及住院部糖尿病肾病患者64例分为阴虚燥热、气阴两虚、脾肾气虚（阳）、阴阳两虚4种本证组和兼湿证、兼瘀证、兼痰瘀证3种标证组,并选择50名健康志愿者为正常对照组（NC组）,所有纳入者以速率散射比浊法测定C反应蛋白。结果：与正常健康人50例作对照,糖尿病肾病患者CRP水平（1.73±2.91）mg/dl明显高于NC组（0.54±0.16）mg/dl,差异具有统计学意义（P〈0.05）。DN各本证证型组血清CRP水平的比较显示,随着证型由阴虚燥热、脾肾气（阳）虚、气阴两虚、阴阳两虚的演变,患者血清CRP水平逐渐升高,且阴虚燥热、脾肾气虚、气阴两虚分别与阴阳两虚组比较,结果差异均有统计学意义（P〈0.05）。标证中,痰瘀证与NC组、无兼证组与NC组及痰瘀证与血瘀证组比较,差异均具有统计学意义（P〈0.01）。结论：血CRP水平与中医证型相关,在一定程度上为中医辨证分型提供客观依据。     

Changes of the peripheral blood endothelial progenitor cells in peritoneal dialysis patients and its impact factors

Objective To investigate the number and activities changes of peripheral blood endothelial progenitor cells (EPCs) in continuous ambulatory peritoneal dialysis (CAPD) patients, and explore the connection between EPCs' number and the levels of advanced glycosylation end products (AGEs), homocysteine (Hcy) and C-reactive protein (CRP). Methods Twenty-five CAPD patients and thirty healthy volunteers were involved. Total mononuclear cells (MNCs) were isolated from peripheral blood of patients. EPCs were characterized as adherent cells by double staining of FITC-UEA-1 and DiL-AcLDL binding, and were further demonstrated by positive cells of CD34, CD133 and KDR using flow cytometry. The abilities of cell proliferation, adhesion and migration were further observed by fluorescent microscope. The correlations between the CEPCs' number and the levels of AGEs, Hcy andCRP were analyzed. Results The number and activities including migration and adhesion of EPCs in CAPD group were significantly lower than control group (P＜0.05). The levels of serum AGEs, Hcy and CRP in CAPD patients were increased (all P＜0.05) and had negative correlation with EPCs' number. Conclusions The number and activities of EPCs decrease in patients with CAPD, and EPCs' number is negatively correlated to the levels ofAGEs, Hcy and CRP.     

High Pretransplant Serum Levels of CXCL10/IP-10 Are Related to Increased Risk of Renal Allograft Failure

In experimental models, the chemokine CXCL10/IP-10 is required for graft failure owing to both acute and chronic rejection. In the present study, pretransplantation sera from 316 cadaver kidney graft recipients were tested for serum CXCL10 and CCL22/MDC levels by an ELISA assay. Kidney graft recipients with normally functioning grafts showed significantly lower serum CXCL10 levels than patients who experienced graft failure, whereas no differences for serum CCL22 levels were observed. After the assignment of all patients to four groups according to serum CXCL10 levels, the death-censored survival rates of grafts were 97.5%, 93.6%, 89.7%, 78.7% (p = 0.0006) at 5 years, while no influence was observed on patient survival. Accordingly, patients with the highest CXCL10 levels showed an increased frequency and severity of rejection episodes. Serum C-reactive protein (CRP) level was also assayed in the same samples. Increase of serum CRP levels represented a predictive parameter for death, but not for graft failure. Multivariate analysis demonstrated that among the analyzed variables, CXCL10 had the highest predictive power of graft loss (RR 2.787). Thus, measurement of pretransplant serum CXCL10 levels might represent a clinically useful parameter to identify subjects who are at high risk of severe rejection and graft failure.     

No effect of C-reactive protein (CRP) haplotypes on CRP levels and post-transplant morbidity and mortality in renal transplantation

Increased serum C-reactive protein (CRP) levels have been associated with all-cause and cardiovascular mortality after kidney transplantation. As genetic variations within the CRP gene determine CRP serum levels, we analyzed the association of both serum CRP levels, and post-transplant morbidity/mortality with CRP-genotypes/haplotypes. We determined CRP levels pretransplant, at 3 and 6 months post-transplant in 402 first kidney recipients, genotyped the three functionally distinct polymorphisms, and subsequently reconstructed the different haplotypes. Four different CRP-haplotypes were observed with a frequency >1%: CGC (33.3%), CGT (30.2%), CAT (29.7%) and GGT (6.8%). CRP levels pretransplantation or 3 and 6 months post-transplant were not different in patients with different CRP-haplotypes. Furthermore, no association of CRP-haplotypes/diplotypes was found with acute rejection, delayed graft function, all-cause mortality or cardiovascular events. In our renal transplant population, we found no association of CRP-haplotypes/diplotypes with either CRP levels or with post-transplant morbidity/mortality. In this inflammation-prone population, rather small genetically determined differences in serum CRP observed in normal populations presumably are overridden by background inflammation. Life long genetically determined increased serum CRP levels appear not to have an impact in our study, implying that CRP is more likely only a marker of current inflammation than a causative agent of cardiovascular morbidity and mortality.     

The significance of serum peptidylarginine deiminase type 4 in ANCA - associated vasculitis

Objective To explore the significance of peptidylarginine deiminase type 4 (PAD4) in the pathogenesis of ANCA-associated vasculitis (AAV) by detecting its level in patients with AAV. Methods Sera from 13 patients with AAV, 11 patients with primary chronic kidney disease and 12 healthy controls were collected. Serum PAD4 was detected using commercial ELISA kits. The association between serum PAD4 and BVAS of AAV was further investigated. Results (1) The serum level of PAD4 in patients with AAV in active and remission stages were all higher than that in the healthy controls. The serum level of PAD4 in patients with CKD was not found elevated compared with the normal controls. (2) The serum levels of PAD4 in AAV with renal damage were all significantly higher than that in CKD group no matter in active or remission stage. (3) The serum level of PAD4 in AAV with renal damage in active stage was positively correlated with BVAS (r＝0.71, P＝0.02). Conclusion PAD4 is involved in the pathogenesis of AAV.     

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.     

Circulating serum levels of interleukin 6 and C-reactive protein after liver transplantation.

The study objectives were to investigate serum levels of interleukin-6 and C-reactive protein (CRP) after liver transplantation to correlated measurements with various clinical parameters. Twenty-three patients were studied after orthotopic liver transplantation. Serum IL-6 activity was evaluated by testing its capacity to induce proliferation of the IL-6-dependent hybridoma cell line B9. CRP was assessed by a nephelometric method. Only two of seven patients with acute cellular rejection developed an increase of serum IL-6 and CRP. In contrast to this rejection group, elevated IL-6 levels were observed in 7/9 patients with bacterial infections. Peak values for IL-6 were observed one day and for CRP two days after clinical diagnosis of infection. CMV disease was also associated with markedly increased IL-6 and CRP levels in 5/7 patients. Surprisingly, levels in this condition were approximately in the same range as in bacterial infection. IL-6 and CRP serum levels seen in bacterial infection and CMV disease were significantly higher than those in rejection (P less than 0.001). Serum IL-6 activity was neutralized by an antiserum directed against recombinant human IL-6. Preferential elevations of IL-6 and CRP represent one feature of bacterial and viral infections. Elevation of TNF during rejection as described earlier is only rarely accompanied by increased serum IL-6 levels.     

Evaluation of Serum Levels of Procalcitonin and C-Reactive Protein as Prognostic Indicators in Burns

Background Burn is a leading cause of fatality in a developing country. C-reactive protein levels (CRP) and procalcitonin (PCT) can be prognostic indicators for the burn patients'' mortality. Aim To assess serial levels of serum PCT and serum CRP as prognostic indicators in burns. Patient and Methods In patients admitted with burns, alternate-day serum PCT and CRP were measured from the time of admission until the time of discharge or until survival. The change in trends of CRP and PCT serum levels were studied, and it was then correlated with mortality among these burn patients. Results The first-day value of serum PCT > 1772 pg/mL and serum CRP > 71 mg/mL or any value of serum PCT > 2163 pg/mL and of serum CRP > 90 mg/L indicate a poor prognosis in burns. Conclusions The day-1 values of PCT and CRP were significantly higher in nonsurvivors than survivors in burns. The increasing trends of serum PCT and CRP levels are independent predictors of mortality in burns requiring prompt intervention. Rising PCT and CRP level denote poor prognosis in burns with an increased likelihood of death by 4.5 and 23.6 times, respectively.     

Soluble Fas: a novel marker of inflammation in uremia

BACKGROUND: Inflammation has been associated with atherosclerotic cardiovascular disease (CVD) and anemia in patients with end-stage renal disease (ESRD). Recent studies have shown that serum levels of soluble Fas (sFas), an antiapoptotic and proinflammatory molecule, are elevated in patients with cardiac disease and patients with ESRD. We therefore sought to investigate serum levels of sFas in uremic patients and its correlation with known markers of inflammation, anemia and CVD. METHODS: The study included 25 ESRD patients (14 on hemodialysis, 11 on CAPD), 27 patients with chronic kidney disease (CKD; creatinine clearance <50 ml/min/1.73 m2), and 14 normal control subjects. We measured serum levels of sFas, C-reactive protein (CRP), and albumin. We also investigated the association of serum sFas levels with the presence of CVD and with erythropoietin (EPO) dosage. RESULTS: Levels of sFas were elevated in CKD and ESRD patients compared to controls. sFas levels correlated negatively with creatinine clearance. In the dialysis patients, we observed that sFas levels were higher among those with CVD. Serum levels of sFas correlated with serum levels of CRP (r=0.31; P=0.03), serum levels of albumin (r=-0.35, P=0.02), and EPO dosage (r=0.51; P=0.009). CONCLUSION: These results suggest that sFas may be a marker of inflammation in CKD and ESRD patients.     

Interleukin-2 profiles shortly after tacrolimus conversion from a twice-daily to once-daily regimen

A number of studies have indicated that kidney recipients can be safely converted from the twice-daily formulation (Tac-T) to the same dose of a once-daily tacrolimus (TAC) regimen (Tac-O) based upon monitoring of renal function. Conversion from Tac-T to Tac-O is commonly followed by a reduction in Tac trough levels, estimated by some authors to be about 20%. These alterations seem to not be associated with a modification of graft function, but study of inflammatory cytokines would be useful. The aims of our study were to monitor Tac, C-reactive protein (CRP), and interleukin (IL)-2 levels as well as to evaluate renal function among stable renal transplant patients converted from a Tac-T to a Tac-O regimen. We enrolled 10 consecutive stable kidney transplanted patients. Tac trough levels, serum creatinine concentrations, glomerular filtration rates using the Modification of Diet in Renal Disease formula (MDRD), CRP, and clinical assessment were performed monthly for 6 months before and 3 months after the conversion. After conversion we observed a slight but not significant reduction in Tac trough level. Renal function evaluated by serum creatinine and MDRD as well as CRP were not significantly different after conversion. IL-2 levels remained stable after conversion. We identified a group of patients showing reduced Tac trough levels below the therapeutic range and a group with stable Tac levels. No significant differences were observed among the two groups before versus after the conversion. Our results did not show a modification of IL-2, CRP and renal function levels, at 3 months after conversion despite the lower Tac trough concentrations. The clinical meaning of Tac trough alterations is not clear. They might reflect inter- and intraindividual differences in the clearance of Tac as recently described. They did not seem to be associated with activation of an inflammatory pathway.     

脑肠肽对脓毒症相关性肾损伤的保护作用研究

目的 探讨脑肠肽对内毒素所致大鼠脓毒症相关性肾损伤的影响.方法 健康雄性SD大鼠36只,随机分为3组：正常对照组,急性肾损伤（acute kidney injury,AKI）组,脑肠肽治疗组.采用内毒素静注制备脓毒症AKI模型,脑肠肽治疗组于造模前后30 min给予皮下注射脑肠肽（1.0mg/kg）,选择不同时间点（6 h、12 h、24 h）处死动物后留取血标本和肾组织,检测血清肌酐（SCr）、尿素氮（BUN）、血清肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、观察肾组织的病理变化并检测肾脏组织中核因子κB的活化.结果 与同时间点比较,AKI组6h和12 h大鼠血清中TNF-α表达水平明显升高（P＜0.01）,24 h降至对照组水平（P＞0.05）,AKI组6h、12 h和24 h大鼠血清中BUN水平逐渐升高（P＜0.05）,24 h血清中SCr水平明显升高（P＜0.01）;AKI组24 h大鼠肾脏组织核因子κB p65核阳性率明显升高（P＜0.01）.脑肠肽治疗组对应时间点血清BUN和SCr水平较AKI组明显降低（P＜0.01）.TNF-α和核因子κB p65表达明显低于AKI组（P＜0.01）.病理显示脑肠肽治疗组大鼠肾损伤减轻,SCr、BUN、TNF-α、光镜检查均未见明显差异.结论 脑肠肽可通过抑制肾组织核因子κB的表达,下调TNF水平,对脓毒症相关性肾损伤发挥保护作用.     

辛伐他汀对糖尿病肾脏病微炎症状态的影响

目的观察糖尿病肾脏病（DKD）微炎症状态及辛伐他汀对微炎症状态的影响。方法选择2010年1月至2010年12月在我科住院并长期随访的DKD患者60例,根据。肾小球滤过率（GFR）水平,将所有患者分为3组,其中慢性肾脏病（CKD）3期组19例,CKD4期组23例,CKD5期组18例。同时从我科医护人员中选取20名健康志愿者为正常对照组。对CKD3、4、5期组患者给予辛伐他汀口服,每次40mg,每晚1次,连用8周。分别在治疗前、后测定患者血清白细胞介素（IL）-6、C反应蛋白（CRP）、铁蛋白、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）等。并测定正常对照组IL-6、CRP、铁蛋白等微炎症指标。结果与正常对照组相比,CKD3、4、5期组治疗前IL-6、CRP较高（P〈0．05）,CKD5期组铁蛋白较高（P〈0．05）。治疗后,CKD3、4、5期组IL-6、CRP、铁蛋白较治疗前降低（P〈0．05）,CKD4、5期组LDL降低（P〈0．05）,CKD3期组LDL及各组TG、TC治疗前、后差异无统计学意义（P〉0．05）。结论辛伐他汀能够改善DKD患者的微炎症状态,其改善与血脂的下降无明显相关性。     

Levels of bisphenols in patients with chronic kidney disease and their correlation with renal function

Objective To observe the levels of four bisphenols (bisphenol A, B, S and F) and their correlation with renal function in chronic kidney disease (CKD) patients. Methods Patients with CKD were identified according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Sixty-three CKD patients and eleven healthy controls were enrolled. CKD patients were further classified as mild renal injury group (CKD stage 1 and 2, n=30), moderate renal injury group (CKD stage 3, n=19) and severe renal injury group (CKD stage 4 and 5, n=14). The levels of four bisphenols in serum were determined by high performance liquid chromatography (HPLC). The correlation between concentrations of four bisphenols and estimated glomerular filtration rate (eGFR) was assessed by Spearman's rank correlation analysis. The associations of four bisphenols with coronary heart disease, diabetes and hypertension in CKD patients were estimated by binary multivariate logistic regression. Results (1) Four bisphenols were not detected in serum of healthy control. In the mild renal injury group the bisphenol A and bisphenol S were not detected, and patients had 5.24 (5.24, 9.38) μg/L bisphenol B and 0.74 (0.74, 0.74) μg/L bisphenol F. In the moderate renal injury group bisphenol S was not detected, and patients had 2.79 (1.01, 4.53) μg/L bisphenol A, 5.24 (5.24, 5.24) μg/L bisphenol B and 0.74 (0.74, 0.74) μg/L bisphenol F. In severe renal injury group patients had 14.30 (7.97, 18.17) μg/L bisphenol A, 0 μg/L bisphenol B, 23.73 (23.73, 136.59) μg/L bisphenol S and 0.74 (0.74, 1.42) μg/L bisphenol F. The levels of bisphenol A and bisphenol S in severe renal injury group were higher than those in the healthy control group, mild renal injury group and moderate renal injury group (all P＜0.05). Bisphenol B and bisphenol F were not statistically different among four groups. (2) Bisphenol A and bisphenol S were negatively correlated with eGFR (r=-0.779, P＜0.001; r=-0.546, P＜0.001). (3) Among CKD patients, bisphenol A was correlated with diabetes (OR=4.951, 95%CI 1.603-15.294, P=0.005), and bisphenol S was correlated with hypertension (OR=4.466, 95%CI 1.575-12.666, P=0.005). Conclusions CKD patients have a variety of bisphenol compounds, especially bisphenol A and bisphenol S. Bisphenol A and bisphenol S have high levels, and their exposures are correlated with renal function.     

Serum matrix metalloproteinases MMP-2 and MMP-3 levels in dialysis patients vary independently of CRP and IL-6 levels

BACKGROUND: Patients on chronic hemodialysis or peritoneal dialysis often develop an inflammatory state that causes morbidity and mortality. Cross-sectional studies of dialysis patients have determined that C-reactive protein (CRP) is a predictor of morbidity. Little is known as to whether CRP, cytokines, such as IL-6 and IL-1beta that stimulate the synthesis of CRP, or matrix metalloproteinases (MMPs) are markers of inflammation in patients on dialysis. METHODS: We assayed by ELISA serum levels of MMP-2, MMP-3, IL-6 and CRP in healthy individuals and in patients with pre-end-stage renal disease (pESRD, n = 10), peritoneal dialysis (PD, n = 11), hemodialysis (HD, n = 17) and renal transplant (TX, n = 10). RESULTS: MMP-2 was significantly elevated before dialysis, perhaps indicative of progressive chronic renal sclerosis. MMP-3 was markedly elevated in hemodialysis patients but not in pESRD or PD patients, and may be related to the hemodialysis process and/or accelerated atherogenesis in these patients. IL-6 was significantly elevated in all patient groups, including pESRD patients. There were no statistically significant differences in CRP levels among the study groups. CRP correlated with IL-6, but not with MMP-2 or MMP-3. CONCLUSIONS: The data indicate that there are measurable differences in the expression of MMPs within the dialysis patient population. Because dialysis can be associated with local and systemic inflammation, increased levels of MMP-3 in the hemodialysis group may be a reflection of gene stimulation induced by inflammatory cytokines and should be considered as a marker of chronic, local inflammation.     

Factors associated with serum leptin in patients with chronic kidney disease

BACKGROUND AND AIMS: Serum leptin levels are elevated in patients with kidney failure. Data on the associations of serum leptin and on the relationship of leptin with both kidney function and inflammation, are limited in patients with reduced glomerular filtration rate (GFR). We evaluated the independent associations of serum leptin in patients with reduced GFR. MATERIAL AND METHODS: Serum leptin and C-reactive protein (CRP) were measured in samples from 798 participants of the Modification of Diet in Renal Disease Study. Multivariable analysis was used to evaluate the independent effects of kidney function and CRP on leptin levels. RESULTS: Median (interquartile range) of serum leptin was 9.1 ng/ml (14.0). Female gender, higher percent body fat, higher insulin levels, older age, lower GFR and higher CRP were associated with higher serum leptin levels and explained 51% of the variability in the logarithm of serum leptin levels. After adjusting for the other variables, a 10 ml/min/1.73 m2 lower GFR was associated with 6% higher mean serum leptin levels. Percent body fat and gender, explained 45% of the variability in serum leptin levels. CONCLUSIONS: Level of kidney function and CRP are associated with serum leptin in patients with reduced GFR. However, there is a stronger association between serum leptin and indices of body fat and gender in patients in the earlier stages of chronic kidney disease. 50% of the variability remains unexplained in patients with reduced GFR.     

Procalcitonina y proteína C reactiva como marcadores precoces de infección intraabdominal postoperatoria en pacientes operados de cáncer gastrointestinal

Aim

to evaluate the association between serum levels of procalcitonin and C-reactive protein, on the first 3 postoperative days, and the appearance of postoperative intra-abdominal infection.

Method

Prospective observational study including 67 patients operated on for colo-rectal, gastric and pancreatic cancer. Serum levels of procalcitonin and C-reactive protein were analyzed before surgery and daily until the third postoperative day. Values of procalcitonin (PCT) and C-reactive protein (CRP) were recorded as well as their accuracy for detection of postoperative intra-abdominal infection (PIAI).

Results

The incidence of postoperative intra-abdominal infection was 13.4%. CRP serum levels at 72 h, PCT serum levels at 24, 48 and 72 h and the ratio between serum levels of CRP at 72 hours and serum levels of CRP at 48 hours (CRP D3/CRP D2) were significantly associated with the appearance of postoperative intra-abdominal infection. The highest sensitivity corresponded to PCT at 72 hours (88.9%); the highest specificity and positive predictive value corresponded to the ratio CRP D3/CRP D2 (96.49% and 71.4%, respectively); the highest negative predictive value to procalcitonin at 72 h and 24 h.

Conclusions

Serum levels of PCT are significantly associated with the appearance of postoperative intra-abdominal infection. Sensitivity and predictive positive values are low, but negative predictive value is high, even at 24 h after surgery.     

腹腔镜手术治疗消化性溃疡穿孔对机体炎症反应及免疫功能的影响

目的 探讨腹腔镜手术治疗消化性溃疡穿孔对机体炎症反应及免疫功能的影响,进一步评价腹腔镜穿孔修补术的微创效果.方法 将81例消化性溃疡穿孔患者随机分为腹腔镜手术组（腹腔镜组,37例）和开腹手术组（开腹组,44例）,比较两组患者围手术期外周血降钙素原（PCT）、C反应蛋白（CRP）及T淋巴细胞亚群（CD4、CD8、CD4/CD8比值）变化.结果 术后第1天、第3天两组的PCT、CRP均较术前显著升高（P＜0.05）.术后第5天腹腔镜组的PCT、CRP水平与术前比较,差异无统计学意义（P＞0.05）.术后开腹组的PCT、CRP水平均显著高于腹腔镜组（P＜0.05）.两组术后第1天CD4、CD8水平及CD4/CD8比值均较术前显著下降（P＜0.05）,但术后腹腔镜组CD4、CD8水平及CD4/CD8比例明显高于开腹组（P＜0.05）,且腹腔镜组CD4、CD8水平及CD4/CD8比值均于术后第5天恢复至术前水平（P＞0.05）.结论 与开腹穿孔修补术相比较,腹腔镜穿孔修补术能够有效降低术后炎症反应的程度,且对机体的免疫功能影响更小,具有功能学微创优势.