Clinical consequences of intermittent elevation of C-reactive protein levels in hemodialysis patients.
Clinical consequences of intermittent elevation of C-reactive protein levels in hemodialysis patients.
复制标题
血液透析患者 C 反应蛋白水平间歇性升高的临床后果。
DOI：
10.1111/j.1492-7535.2004.0085aq.x
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发表时间：
2004
影响因子：
0.9
通讯作者：
M. Haberal
中科院分区：
文献类型：
--
作者：
S. Sezer;E. Külah;F. Ozdemir;E. Tutal;Z. Arat;M. Haberal
C-反应蛋白（CRP）水平升高与营养不良、血液透析（HD）治疗期间促红细胞生成素抵抗以及慢性移植排斥反应风险较高相关。同时，在一个大的HD患者群体中观察到的CRP水平间歇性升高的临床后果尚不清楚。我们试图比较持续或间歇性CRP升高的HD患者与CRP水平在正常范围内的受试者的炎症和营养参数以及促红细胞生成素需求。100例血液透析患者6个月回顾性临床和实验室资料根据至少6个月的CRP值将受试者（年龄48.4 ± 14.3岁，HD持续时间69.3 ± 49.0个月）分为3组：持续性（第1组）或间歇性高（至少一个CRP水平>/=10 mg/L）;（组2）与正常CRP水平（组3）。我们比较了纤维蛋白原、ICAM-1、VCAM-1、白蛋白、前白蛋白、标准化蛋白分解代谢率（nPCR）、透析间期体重增加（IDWG）和rhuuEpo/kg/Htc的估计值。在纤维蛋白原、白蛋白、前白蛋白、ICAM-1、nPCR、IDWG和rHUuEpo/kg/wk值中观察到显著差异。与第1组一样，第2组患者似乎显示出炎症和营养不良，即与第3组相比，白蛋白水平、nPCR和rHUEpo抵抗降低。最后，CRP的间歇性升高必须被认为反映了与营养不良和促红细胞生成素抵抗相关的慢性炎症反应状态，类似于在持续高CRP水平的血液透析患者中观察到的情况。
An elevated C-reactive protein (CRP) level has been associated with malnutrition, with erythropoietin resistance during hemodialysis (HD) therapy, and with a higher risk of chronic transplant rejection. Meanwhile, the clinical consequences of intermittent elevations of CRP levels observed among a large group of HD patients are unclear. We sought to compare the inflammatory and nutritional parameters as well as the erythropoietin requirements for HD patients with persistent or intermittent CRP elevations versus subjects with CRP levels in the normal range. The 6-month retrospective clinical and laboratory data of 100 HD patients (age 48.4 +/- 14.3 years, HD duration 69.3 +/- 49.0 months) were divided into three groups on the basis of at least six monthly values of CRP: for persistent (group 1) or intermittent high (at least one level of CRP >/=10 mg/L); (group 2) versus normal CRP levels (group 3). We compared the estimates of fibrinogen, ICAM-1, VCAM-1, albumin, prealbumin, normalized protein catabolic rate (nPCR), interdialytic weight gain (IDWG), and rhuuEpo/kg/Htc. Significant differences, were observed in fibrinogen, albumin, prealbumin, ICAM-1, nPCR, IDWG, and rHUuEpo/kg/wk values. Like group 1, group 2 patients seemed to show inflammation and malnutrition, namely decreased albumin levels, nPCR, and rHUEpo resistance, when compared with group 3. Finally, intermittent elevations of CRP must be considered to reflect a state of chronic inflammatory response associated with malnutrition and erythropoietin resistance similar to that observed among hemodialysis patients with persistently high CRP levels.