Relationship between erythropoietin responsiveness, insulin resistance, and malnutrition-inflammation-atherosclerosis (MIA) syndrome in hemodialysis patients with diabetes
Relationship between erythropoietin responsiveness, insulin resistance, and malnutrition-inflammation-atherosclerosis (MIA) syndrome in hemodialysis patients with diabetes
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DOI：
10.5301/ijao.2011.6314
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发表时间：
2011-01-01
影响因子：
1.7
通讯作者：
Soma, Masayoshi
中科院分区：
文献类型：
--
作者：
Abe, Masanori;Okada, Kazuyoshi;Soma, Masayoshi
背景：本研究旨在探讨血液透析患者重组人促红细胞生成素(EPO)反应性、胰岛素抵抗与营养不良-炎症-动脉粥样硬化(MIA)综合征的关系。糖尿病组(DM；n=58)和非糖尿病组(Non-DM；n=58)的脂肪因子、炎性细胞因子和所需EPO剂量在48周内被检测。结果：DM组血浆瘦素、白介素6(IL-6)、超敏C反应蛋白(hs-CRP)水平明显高于非DM组，而高分子脂联素(HMW)水平明显低于非DM组。虽然血红蛋白水平没有显著差异，但糖尿病组所需EPO剂量显著高于非糖尿病组，尤其是在存在MIA综合征的情况下。糖尿病合并MIA组与非糖尿病合并MIA组比较，血浆瘦素、IL-6、hs-CRP水平显著升高，HMW-脂联素水平显著降低。糖尿病合并MIA综合征患者EPO用量与胰岛素抵抗(HOMA-IR)、超敏C反应蛋白(hs-CRP)、IL-6、肿瘤坏死因子α、瘦素、高分子脂联素水平显著相关。结论：糖尿病MIA综合征血透患者对EPO的反应较低，对胰岛素的抵抗较高。这一事实可能解释了这些患者预后不佳的原因，并证明了诊断和治疗管理的重要性。
Background: This study aimed to explore the relationship between recombinant human erythropoietin (EPO) responsiveness, insulin resistance, and malnutrition-inflammation-atherosclerosis (MIA) syndrome in hemodialysis patients.Methods: This was an observational cohort study in hemodialysis patients. Adipokines, inflammatory cytokines, and required EPO dosage were measured in diabetes (DM; n=58) and non-diabetes (non-DM; n= 58) groups over 48 weeks. Furthermore, the EPO responsiveness index (required EPO dosage divided by hemoglobin) was evaluated with or without MIA syndrome in both groups.Results: The DM group had significantly higher plasma leptin, interleukin-6 (IL-6), and high sensitivity C-reactive protein (hs-CRP) levels but lower plasma high molecular weight (HMW) adiponectin levels compared to the non-DM group. Although hemoglobin levels were not significantly different, required EPO dosage was significantly higher in the DM group than in the non-DM group, particularly in the presence of MIA syndrome. The DM group with MIA syndrome had significantly higher plasma leptin, IL-6, and hs-CRP levels but lower plasma HMW adiponectin levels compared to the non-DM group with MIA syndrome. There was also a significant association between EPO dosage and homeostasis model assessment for insulin resistance (HOMA-IR), hs-CRP, IL-6, tumor necrosis factor alpha, leptin, and HMW adiponectin levels in DM patients with MIA syndrome.Conclusion: Diabetic hemodialysis patients with MIA syndrome have a lower response to EPO and a higher resistance to insulin. This fact may explain the poor outcome of these patients and demonstrate the importance of diagnosis and therapeutic management.