Biochemistry and Biomarkers of Inflamed Patients: Why Look, What to Assess
Biochemistry and Biomarkers of Inflamed Patients: Why Look, What to Assess
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DOI：
10.2215/cjn.03090509
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发表时间：
2009-12-01
影响因子：
9.8
通讯作者：
Kaysen, George A.
中科院分区：
文献类型：
--
作者：
Kaysen, George A.
具体的实验室检查和物理检查结果可提供给执业临床医生，应提高炎症的怀疑。炎症与特定的临床结果有关。一旦确定，临床实践的变化可能会影响透析患者个人或群体的炎症水平，希望这些变化反过来以积极的方式影响结果。与炎症相关的标准临床试验和观察结果为低白蛋白血症、促红细胞生成素抵抗、铁饱和度降低伴高铁蛋白、虚弱、血清肌酐低、总胆固醇和低密度脂蛋白胆固醇降低、C反应蛋白（CRP）升高。炎症与身体功能丧失、血脂异常（低LDL-和hdl -胆固醇、甘油三酯升高）和对促红细胞生成素无反应的贫血密切相关。炎症与心血管事件、住院率增加和死亡有关。可纠正的炎症原因是隧道透析导管、动静脉移植物、导管感染、牙周病、水质差和透析器不相容。肥胖也是细胞因子的一个来源，但可能不太容易治疗。透析患者的炎症是多因素的。有些来源是可识别和可纠正的，如血管通路类型、临床感染和水质，而有些则不是。炎症与预后密切相关。中国临床医学杂志，2009,31(4):556 - 563。doi: 10.2215 / CJN.03090509
Specific laboratory tests and physical findings are available to the practicing clinician that should raise the suspicion of inflammation. Inflammation is related to specific clinical outcomes. Once identified, changes in clinical practice may affect the level of inflammation in individual and or groups of dialysis patients with the hope that these changes may in turn affect outcome in a positive manner. Standard clinical tests and observations associated with inflammation are hypoalbuminemia, erythropoietin resistance, decreased iron saturation accompanied by high ferritin, frailty, low serum creatinine, reduced total and LDL-cholesterol, and increased C reactive protein (CRP). Inflammation is strongly associated with loss of physical function, dyslipidemia (low LDL- and HDL-cholesterol, increased triglycerides), and anemia that is unresponsive to erythropoietin. Inflammation is associated with cardiovascular events, increased hospitalization, and death. Correctible causes of inflammation are tunneled dialysis catheters, arteriovenous grafts, catheter infection, periodontal disease, poor water quality, and dialyzer incompatibility. Obesity also is a source of cytokines but may be less amenable to treatment. Inflammation is multifactorial in dialysis patients. Some sources are recognizable and correctable, such as vascular access type, clinical infection, and water quality, and some are not. Inflammation is strongly associated with outcome. Clin J Am Soc Nephrol 4: S56-S63, 2009. doi: 10.2215/CJN.03090509