Adiponectin, metabolic risk factors, and cardiovascular events among patients with end-stage renal disease
Adiponectin, metabolic risk factors, and cardiovascular events among patients with end-stage renal disease
复制标题
DOI：
10.1681/asn.v131134
复制
发表时间：
2002-01-01
影响因子：
13.6
通讯作者：
Matsuzawa, Y
中科院分区：
文献类型：
--
作者：
Zoccali, C;Mallamaci, F;Matsuzawa, Y
脂联素（Adiponectin，ADPN）是脂肪组织的一种分泌蛋白，在体外可减轻内皮细胞的炎症反应.在人类受试者中，动脉粥样硬化并发症患者的血浆ADPN浓度降低，但晚期肾衰竭患者的血浆ADPN浓度显著升高。研究了血浆ADPN水平的临床和生化相关性，并在227例血液透析患者的队列中前瞻性检验了ADPN水平对生存率和心血管事件的预测能力，这些患者监测了31 +/- 13个月。透析患者的血浆ADPN水平（15.0 ± 7.7 μ g/ml）是健康受试者（6.3 ± 2.0 μ g/ml）的2.5倍（P < 0.0001），与年龄无关，女性（15.2 ± 7.9 μ g/ml）高于男性（14.0 ± 7.4 μ g/ml）（P = 0.03）。对于两种性别，血浆ADPN水平与体重指数值、血浆瘦素水平、胰岛素水平、血清甘油三酯水平和稳态模型评估指数值呈负相关。此外，血浆ADPN水平与HDL胆固醇水平直接相关，与血管性血友病因子水平呈负相关。发生新心血管事件的患者血浆ADPN水平（13.7 ± 7.3 μ g/ml）低于无事件患者（15.8 ± 7.8 μ g/ml）（P < 0.05）。血浆ADPN水平每升高1 μ g/ml，风险降低3%，与第三个三分位数的患者相比，第一个三分位数的患者发生不良心血管事件的相对风险高1.56倍（95%置信区间，1.12 - 1.99倍）。血浆ADPN水平是终末期肾病患者心血管结局的逆预测因子。此外，ADPN与几种代谢危险因素相关，其方式与这种蛋白质作为心血管系统保护因子的假设一致。
Adiponectin (ADPN), which is a secretory protein of adipose tissue, attenuates endothelial inflammatory responses in vitro. Among human subjects, plasma ADPN concentrations are reduced among patients with atherosclerotic complications but are substantially increased among patients with advanced renal failure. The clinical and biochemical correlates of plasma ADPN levels were investigated and the predictive power of ADPN levels with respect to survival rates and cardiovascular events was prospectively tested in a cohort of 227 hemodialysis patients, who were monitored for 31 +/- 13 mo. Plasma ADPN levels were 2.5 times higher (P < 0.0001) among dialysis patients (15.0 +/- 7.7 g/ml) than among healthy subjects (6.3 +/- 2.0 mug/ml), were independent of age, and were higher (P = 0.03) among women (15.2 +/- 7.9 mug/ml) than among men (14.0 +/- 7.4 mug/ml). For both genders, plasma ADPN levels were inversely related to body mass index values, plasma leptin levels, insulin levels, serum triglyceride levels, and homeostatic model assessment index values. Furthermore, plasma ADPN levels were directly related to HDL cholesterol levels and inversely related to von Willebrand factor levels. Plasma ADPN levels were lower (P < 0.05) among patients who experienced new cardiovascular events (13.7 +/- 7.3 g/ml) than among event-free patients (15.8 +/- 7.8 mug/ml). There was a 3% risk reduction for each 1 mug/ml increase in plasma ADPN levels, and the relative risk of adverse cardiovascular events was 1.56 times (95% confidence interval, 1.12 to 1.99 times) higher among patients in the first ADPN tertile, compared with those in the third tertile. Plasma ADPN levels are an inverse predictor of cardiovascular outcomes among patients with endstage renal disease. Furthermore, ADPN is related to several metabolic risk factors in a manner consistent with the hypothesis that this protein acts as a protective factor for the cardiovascular system.