Associations between circulating inflammatory markers and residual renal function in CRF patients
Associations between circulating inflammatory markers and residual renal function in CRF patients
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DOI：
10.1016/s0272-6386(03)00353-6
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发表时间：
2003-06-01
影响因子：
13.2
通讯作者：
Stenvinkel, P
中科院分区：
文献类型：
--
作者：
Pecoits, R;Heimbürger, O;Stenvinkel, P
背景慢性肾功能衰竭患者循环中细胞因子和其他炎症标志物水平显著升高。这可能是由生成量增加、移除减少或两者兼而有之造成的。然而，肾功能本身在多大程度上对尿毒症促炎环境的影响还没有很好的确定。本研究的目的是分析176例患者(年龄52+/-1岁，肾小球滤过率6.5+/-0.1毫升/分钟)在肾脏替代治疗开始前炎症反应与肾小球滤过率(GFR)的关系。方法：隔夜禁食后测定循环超敏C反应蛋白(HsCRP)、肿瘤坏死因子-α(TNF-α)、白介素6(IL-6)、透明质酸(HA)和新喋呤(Neopterin)水平。随后，根据GFR中位数(6.5毫升/分钟)将患者分为两组。结果尽管GFR的范围较窄(1.80~16.5mL/m in)，但GFRS较低的亚组hsCRP、透明质酸和新喋呤水平显著升高，且GFR与IL-6(Rho=-0.18；P<；0.05)、透明质酸(Rho=-0.25；P<；0.001)和新喋呤(Rho=-0.32；P<；0.0005)呈显著负相关。在多因素分析中，虽然年龄和肾小球滤过率与炎症有关，但心血管疾病和糖尿病与炎症无关。结论：低GFR本身与炎症状态有关，提示肾脏对促炎细胞因子的清除受损，尿毒症患者细胞因子生成增加，或炎症对肾功能的不利影响。
Background Circulating levels of cytokines and other inflammation markers are markedly elevated in patients with chronic renal failure. This could be caused by increased generation, decreased removal, or both. However, it is not well established to what extent renal function per se contributes to the uremic proinflammatory milieu. The aim of the present study is to analyze the relationship between inflammation and glomerular filtration rate (GFR) in 176 patients (age, 52 +/- 1 years; GFR, 6.5 +/- 0.1 mL/min) close to the initiation of renal replacement therapy. Methods: Circulating levels of high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), hyaluronan, and neopterin were measured after an overnight fast. Patients subsequently were subdivided into two groups according to median GFR (6.5 mL/min). Results Despite the narrow range of GFR (1.8 to 16.5 mL/min), hsCRP, hyaluronan, and neopterin levels were significantly greater in the subgroup with lower GFRs, and significant negative correlations were noted between GFR and IL-6 (rho = -0.18; P < 0.05), hyaluronan (rho = -0.25; P < 0.001), and neopterin (rho = -0.32; P < 0.0005). In multivarlate analysis, although age and GFR were associated with inflammation, cardiovascular disease and diabetes mellitus were not. Conclusion: These results show that a low GFR per se is associated with an inflammatory state, suggesting impaired renal elimination of proinflammatory cytokines, increased generation of cytokines in uremia, or an adverse effect of inflammation on renal function.