Relationships among inflammation nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients
Relationships among inflammation nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients
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DOI：
10.1046/j.1523-1755.2002.00076.x
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发表时间：
2002-06-01
影响因子：
19.6
通讯作者：
Levin, NW
中科院分区：
文献类型：
--
作者：
Kaysen, GA;Dubin, JA;Levin, NW
背景。血清白蛋白浓度是其合成率、分解代谢率 (FCR)、分布、血浆池稀释度和外部损失之间的平衡。尽管低白蛋白血症与死亡率过高有关，但确定血液透析患者血清白蛋白水平的生理基础尚未确定。白蛋白浓度与多种急性期蛋白 (APP)、C 反应蛋白 (CRP)、α1 酸性糖蛋白 (α1 AG) 或铜蓝蛋白的水平以及营养标记物（例如标准化蛋白质分解代谢率 (nPCR)）相关。方法。为了建立调节白蛋白水平的参数与营养和炎症标志物之间的关系，我们向参加 HEMO 研究的 64 名血液透析患者注射了 [(125) I]-白蛋白，以测量白蛋白分布、合成和 FCR。这些变量与急性期蛋白（APP）、nPCR、体重指数（BMI）、外部白蛋白损失以及人口统计学变量的水平有关。白蛋白分布、合成和 FCR 以及初始血浆体积 (PV) 均通过动力学模型计算。每周测量血清白蛋白、转铁蛋白、CRP、铜蓝蛋白和α1 AG。每周一次透析期间收集透析液以测量白蛋白损失。通过多元线性回归分析结果。结果。白蛋白浓度与其合成率和 FCR 相关，但与 PV 或其在血管和血管外池之间的分布无关。白蛋白浓度还与 nPCR 和 alpha1 AG 相关。然而，白蛋白合成与 PV 和 BMI（或 nPCR）直接相关性最强，但与 APP 水平无关。相比之下，白蛋白 FCR 与 α1 AG 和铜蓝蛋白呈正相关。结论。透析患者的白蛋白浓度分别通过炎症和营养状况对白蛋白分解代谢和合成的影响而变化。在这些患者的白蛋白水平范围内，营养变量主要影响白蛋白合成，而炎症通过增加白蛋白 FCR 导致低白蛋白血症。白蛋白合成也与PV成比例增加。其结果是 PV 扩张不会导致低蛋白血症。
Background. Serum albumin concentration is a balance among its synthesis rate, fractional catabolic rate (FCR), distribution, dilution in the plasma pool and external loss. The physiologic bases for establishing the level of serum albumin in hemodialysis patients have not been defined despite the association of hypoalbuminemia with excess mortality. Albumin concentration is associated with the levels of several acute phase proteins (APPs), C-reactive protein (CRP), alpha1 acid glycoprotein (alpha1 AG), or ceruloplasmin, and with nutritional markers, such as normalized protein catabolic rate (nPCR).Methods. To establish the relationship among parameters that regulate albumin levels and markers of nutrition and inflammation, we injected [(125) I]-albumin, into 64 hemodialysis patients enrolled in the HEMO study to measure albumin distribution, synthesis and FCR. These variables were related to the levels of acute phase proteins (APPs), nPCR, body mass index (BMI), external albumin loss as well as demographic variables. Albumin distribution, synthesis and FCR were calculated from kinetic modeling, as was the initial plasma volume (PV). Serum albumin, transferrin, CRP, ceruloplasmin and alpha1 AG were measured weekly. Dialysate was collected during one dialysis each week to measure albumin loss. Results were analyzed by multiple linear regression.Results. Albumin concentration correlated with its synthesis rate and FCR, but not with PV or its distribution between the vascular and extravascular pools. Albumin concentration also correlated with nPCR and alpha1 AG. However, albumin synthesis was directly related most strongly to PV and BMI (or nPCR), but not to levels of APPs. By contrast, albumin FCR correlated positively with both alpha1 AG and ceruloplasmin.Conclusion. Albumin concentration in dialysis patients changes with inflammation and nutritional status through their effects on albumin catabolism and synthesis, respectively. Within the range of albumin levels in these patients, nutritional variables primarily affected albumin synthesis while inflammation caused hypoalbuminemia by increasing albumin FCR. Albumin synthesis also increased in proportion to PV. The result of this is that PV expansion does not contribute to hypoalbuminemia.