Changes in adiponectin and the risk of sudden death, stroke, myocardial infarction, and mortality in hemodialysis patients
Changes in adiponectin and the risk of sudden death, stroke, myocardial infarction, and mortality in hemodialysis patients
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DOI：
10.1038/ki.2009.200
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发表时间：
2009-09-01
影响因子：
19.6
通讯作者：
Wanner, Christoph
中科院分区：
文献类型：
--
作者：
Drechsler, Christiane;Krane, Vera;Wanner, Christoph
脂联素是一种脂肪细胞特异性细胞因子，在心血管疾病的发生发展中具有保护作用。随着慢性肾脏疾病的进展，脂联素水平升高，心血管风险特征改变。在德国糖尿病和透析研究中，我们确定了1255名2型糖尿病血液透析患者脂联素的基线和纵向变化与不同心血管结局的关系。在4年的随访中，确定了达到预先指定的、判定的终点的危险比。在基线水平高脂联素水平时观察到的心血管事件风险增加与猝死和中风的高风险相关，但与心肌梗死无关。脂联素与C反应蛋白呈负相关，与NT-Pro-BNP呈正相关，后者显著降低与不良结局的相关性。随访期间纵向脂联素水平升高与心血管不良结局和死亡的风险增加相关；相关关系因NT-Pro-BNP增加的混杂效应而减弱。我们的研究表明，透析人群中的高基础脂联素水平和不断增加的脂联素水平在很大程度上反映了疾病环境的后果。最有可能的是，这种上升是对健康恶化的反监管反应，与脂联素抗炎的潜力保持一致。
Adiponectin is an adipocyte-specific cytokine that has a protective role in the development of cardiovascular morbidities. As chronic kidney disease progresses, adiponectin levels increase and cardiovascular risk profiles change. Here we determined the association of baseline and longitudinal changes in adiponectin with different cardiovascular outcomes in 1255 type 2 diabetic hemodialysis patients in the German Diabetes and Dialysis Study. Within 4 years of follow-up, the hazard ratios to reach pre-specified, adjudicated end points were determined. The increased risk of cardiovascular events observed with high adiponectin levels at baseline was associated with high risks of sudden death and stroke but not of myocardial infarction. Adiponectin was negatively correlated with C-reactive protein and positively correlated with NT-pro-BNP, the latter significantly attenuating the associations with adverse outcome. Increased longitudinal levels of adiponectin during follow-up were associated with higher risks of adverse cardiovascular outcomes and death; associations weakened by a confounding effect of increased NT-pro-BNP. Our study suggests that high basal and increasing adiponectin levels in the dialysis population largely reflect a consequence of disease circumstances. Most likely, this rise is a counterregulatory response to worsening health in keeping with adiponectin's potential to counteract inflammation.