Relationship between C-reactive protein, albumin, and cardiovascular disease in patients with chronic kidney disease
Relationship between C-reactive protein, albumin, and cardiovascular disease in patients with chronic kidney disease
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DOI：
10.1016/s0272-6386(03)00407-4
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发表时间：
2003-07-01
影响因子：
13.2
通讯作者：
Sarnak, MJ
中科院分区：
文献类型：
--
作者：
Menon, V;Wang, XL;Sarnak, MJ
背景：C反应蛋白(CRP)水平在肾功能衰竭时升高，可能与营养不良和心血管疾病(CVD)有关。关于早期肾病患者的C反应蛋白水平与肾小球滤过率(GFR)、营养指数和心血管疾病之间的关系的数据有限。方法：对801例肾病患者的饮食调整研究(MDRD)中的C反应蛋白进行检测。比较了MDRD研究和国家健康与营养检查调查(NHANES；1999至2000)之间的CRP分布。在MDRD研究中，研究了C反应蛋白水平与GFR、营养指标、血清白蛋白水平和心血管危险因素之间的关系。结果：调整了年龄和性别的CRIP几何平均数在NHANES(0.23 mg/dL)和MDRD研究(0.22 mg/dL)中相似。在MDRD研究中，CRP水平与体脂和心血管危险因素的测量直接相关，与血清白蛋白水平和能量摄入量负相关，与GFR无关。在调整血清白蛋白水平的其他决定因素的多因素分析中，高C反应蛋白水平(>；0.6 mg/dL)与低0.07g/dL(0.7g/L；95%可信区间[CI]，0.03~0.12)的平均血清白蛋白水平相关。在调整了传统的心血管疾病危险因素后，在高C反应蛋白水平的受试者中，发生心血管疾病的几率是后者的1.73倍(95%可信区间为1.07~2.78)。结论在慢性肾脏病早期，GFR水平似乎不影响CRP水平。C反应蛋白水平与血清白蛋白水平和心血管疾病患病率独立相关。炎症可能参与了以非糖尿病为主的肾脏疾病早期营养不良和心血管疾病的病理生理状态。(C)2003年，由国家肾脏基金会公司提供。
Background C-Reactive protein (CRP) level is elevated in kidney failure and may be related to malnutrition and cardiovascular disease (CVD). Data are limited regarding relationships between CRP levels and glomerular filtration rate (GFR), nutritional indices, and CVD in patients with earlier stages of kidney disease. Methods: CRP was assayed from samples from the Modification of Diet in Renal Disease (MDRD) Study (n = 801). CRP distributions were compared between the MDRD Study and National Health and Nutrition Examination Survey (NHANES; 1999 to 2000). Associations between CRP level and GFR, nutritional indices, serum albumin levels, and CVD risk factors were examined in the MDRD Study. Results: Geometric means of CRIP, adjusted for age and sex, were similar in NHANES (0.23 mg/dL) and the MDRD Study (0.22 mg/dL). In the MDRD Study, CRP level was related directly to measures of body fat and CVD risk factors, inversely with serum albumin level and energy intake, and unrelated to GFR. In multivariable analysis adjusting for other determinants of serum albumin level, high CRP level (>0.6 mg/dL) was associated with a 0.07-g/dL (0.7-g/L; 95% confidence interval [CI], 0.03 to 0.12) lower mean serum albumin level. After adjusting for traditional CVD risk factors, the odds of CVD were 1.73 (95% CI, 1.07 to 2.78) times greater in subjects with a high CRP level. Conclusion GFR level does not appear to influence CRP level in the earlier stages of chronic kidney disease. CRP levels are independently associated with serum albumin level and CVD prevalence. Inflammation may be involved in the pathophysiological state of malnutrition and CVD in the earlier stages of predominantly nondiabetic kidney disease. (C) 2003 by the National Kidney Foundation, Inc.