C-reactive protein: a story half told.
C-reactive protein: a story half told.
复制标题
C反应蛋白：故事讲了一半。
DOI：
10.1046/j.1525-139x.2000.00038.x
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发表时间：
2000
影响因子：
1.6
通讯作者：
Kaysen,GA
中科院分区：
文献类型：
--
作者：
Kaysen,GA
终末期肾病(ESRD)患者的死亡率仍然是一个重要的问题，其死亡率与许多转移性恶性肿瘤相似。在横断面研究中，最有效的死亡率预测因子之一是低血清白蛋白(2)。这被解释为营养不良的存在，可能是部分由于透析不足引起的厌食症所致。很多注意力都集中在通过咨询、膳食补充剂和传统的肠外营养来改善饮食摄入量。在这些努力上花费了大量的金钱和时间，但成效并不显著。营养干预对被认为是营养损害的疾病的效果令人失望，原因有很多。主要的原因可能是低蛋白血症和营养不良的大部分原因是炎症的结果。白蛋白和其他“营养标记物”一样，如前白蛋白(转甲状腺素)(3-6)和转铁蛋白(7)，是一种阴性的急性时相蛋白(8)。这些蛋白质的合成在炎症期间减少，它们的血清浓度也是如此，这种变化完全与营养状态无关(8)。透析患者血清白蛋白浓度与急性期蛋白阳性水平呈负相关。这些蛋白质的合成和血清浓度在炎症过程中增加[C-反应蛋白、血清淀粉样蛋白A(9、10)、纤维蛋白原、铁蛋白]，这种增加受细胞因子[白介素6(IL-6)和肿瘤坏死因子-α(肿瘤坏死因子-α)]增加调节和导致(11、12)。这些炎症标志物在统计学上是终末期肾病患者白蛋白水平的强大决定因素。
Mortality of patients with end-stage renal disease (ESRD) remains a significant problem, with the rate of death similar to that of many metastatic malignancies (1). One of the most powerful predictors of mortality in cross-sectional studies is a low serum albumin (2). This has been interpreted as indicating the presence of malnutrition, possibly resulting from anorexia arising in part from inadequate dialysis. Much attention has been focused on improving dietary intake through counseling, dietary supplements, and intradialytic parenteral nutrition. Much money and time have been spent on these efforts but the benefits have not been impressive. There are a number of reasons for the disappointing effects of nutritional intervention on what has been assumed to be a nutritional lesion. The major one probably arises from the fact that much of the cause of hypoalbuminemia and of malnutrition is the consequence of inflammation.Albumin, like other “nutritional markers” such as prealbumin (transthyretin)(3–6) and transferrin (7), is a negative acute phase protein (8). The synthesis of these proteins decreases during inflammation, as does their serum concentration, changes that occur entirely independently of nutritional state (8). Albumin concentration in dialysis patients is negatively correlated with levels of positive acute phase proteins. These are proteins whose synthesis and serum concentration increase during inflammation [C-reactive protein (CRP), serum amyloid A (SAA)(9, 10), fibrinogen, ferritin], an increase that is regulated by and results from an increase in the cytokines [interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)](11, 12). These markers of inflammation are statistically powerful determinants of albumin level in ESRD patients.