Interleukin-6 predicts hypoalbuminemia, hypocholesterolemia, and mortality in hemodialysis patients
Interleukin-6 predicts hypoalbuminemia, hypocholesterolemia, and mortality in hemodialysis patients
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DOI：
10.1053/ajkd.1998.v32.pm9669431
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发表时间：
1998-07-01
影响因子：
13.2
通讯作者：
Rubin, AL
中科院分区：
文献类型：
--
作者：
Bologa, RM;Levine, DM;Rubin, AL
低血清白蛋白和低血清胆固醇水平是接受血液透析的终末期肾病（ESRD）患者死亡率最一致的预测因素之一。低白蛋白血症常被视为营养不良的标志，但血清白蛋白和胆固醇水平也可能因对急性或慢性炎症的细胞因子介导的急性期反应而降低。在此，我们报告一项为期900天的前瞻性研究结果，该研究旨在确定肿瘤坏死因子 -α（TNF -α）和白细胞介素 -1（IL -6）是否能预测90名无急性感染、住院或手术，且无已知获得性免疫缺陷综合征（AIDS）、恶性肿瘤或肝脏疾病的成年门诊血液透析患者的血清白蛋白和胆固醇水平以及死亡率。在90名患者中的89名患者中检测到了可测量水平的TNF -α和/或IL -6。TNF -α和IL -6与低白蛋白血症和血脂异常的程度之间存在显著关系。在单变量和多变量分析中，IL -6是死亡率最强的预测因子，其次是年龄、白蛋白水平和体重指数（BMI）。尽管本研究未探讨高细胞因子血症的原因，但数据支持低白蛋白血症和低胆固醇血症是对炎症刺激的负性急性期反应这一观点。这些结果表明，努力确定血液透析患者细胞因子产生的刺激因素的性质并降低细胞因子水平，可能对提高接受血液透析患者的生存率有效。（C）1998年，美国国家肾脏基金会
Low serum albumin and low serum cholesterol levels are among the most consistent predictors of mortality in patients with end-stage renal disease (ESRD) undergoing hemodialysis. Hypoalbuminemia is often interpreted as a marker of poor nutrition, but serum albumin and cholesterol levels can also be low as part of a cytokine-mediated acute-phase reaction to acute or chronic inflammation. Here we report the results from a 900-day prospective study designed to determine whether tumor necrosis factor-alfa (TNF-alpha) and interleukin-l (IL-6) predict serum albumin and cholesterol levels and mortality in a group of 90 ambulatory, adult hemodialysis patients with no acute infection, hospitalization or surgery, and no known acquired immunodeficiency syndrome (AIDS), malignancy, or liver disease. Measurable levels of TNF-alpha and/or IL-6 were found in 89 of 90 patients. Significant relationships were found between TNF-alpha and IL-6 and the degree of hypoalbuminemia and dyslipoproteinemia. IL-6 was the strongest predictor of mortality in univariate and multivariate analysis, followed by age, albumin level, and body mass index (BMI). Although the cause of hypercytokinemia was not addressed in this study, the data support the view that hypoalbuminemia and hypocholesterolemia are negative acute-phase responses to inflammatory stimuli. These results suggest that efforts to identify the nature of the stimuli for cytokine production and to lower cytokine levels in hemodialysis patients might be effective in improving the survival of patients undergoing hemodialysis. (C) 1998 by the National Kidney Foundation, Inc.