Circulating TNF Receptors 1 and 2 Predict Mortality in Patients with End-stage Renal Disease Undergoing Dialysis
Circulating TNF Receptors 1 and 2 Predict Mortality in Patients with End-stage Renal Disease Undergoing Dialysis
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DOI：
10.1038/srep43520
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发表时间：
2017-03-03
影响因子：
4.6
通讯作者：
Suzuki, Yusuke
中科院分区：
文献类型：
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作者：
Gohda, Tomohito;Maruyama, Shuntaro;Suzuki, Yusuke
可溶性肿瘤坏死因子（TNF）受体（TNFR：TNFR 1，TNFR 2）的相对高循环水平不仅与糖尿病患者进展为终末期肾病有关，而且与死亡率有关。目前尚不清楚血液透析患者TNFR水平升高是否与死亡率相关。我们研究了319例接受维持性血液透析的患者，随访时间中位数为53个月。用免疫测定法测定TNF途径的循环标志物（TNF α和TNFRs）。TNFR 1与TNFR 2呈显著正相关（r = 0.81，P < 0.0001）。随访期间，88例（27.6%）患者死于任何原因（40例[45.5%]死于心血管疾病）。在考克斯多变量模型中，TNFR而不是TNF α仍然是全因死亡率的重要独立预测因子（TNFR 1：风险比[HR] 2.34，95%置信区间[CI]，1.50-3.64; TNFR 2：HR 2.13，95% CI 1.38-3.29），校正年龄、既往心血管疾病、透析前收缩压后，以及在透析期间收缩压大幅下降。对于心血管死亡率，仅在TNFR 1中观察到显著性（TNFR 1：HR 2.15，95% CI 1.13-4.10）。在接受血液透析的患者中，TNFR水平升高与心血管和/或全因死亡风险相关，与所有相关协变量无关。
Relatively high circulating levels of soluble tumor necrosis factor (TNF) receptors (TNFRs: TNFR1, TNFR2) have been associated with not only progression to end-stage renal disease but also mortality in patients with diabetes. It remains unknown whether elevated TNFR levels in haemodialysis patients are associated with mortality. We studied 319 patients receiving maintenance haemodialysis who were followed for a median of 53 months. Circulating markers of TNF pathway (TNF alpha and TNFRs) were measured with immunoassay. Strong positive correlations between TNFR1 and TNFR2 were observed (r = 0.81, P < 0.0001). During follow-up, 88 (27.6%) patients died of any cause (40 [45.5%] died of cardiovascular disease). In the Cox multivariate model, either TNFR but not TNF alpha remained a significant independent predictor of all-cause mortality (TNFR1: hazard ratio [HR] 2.34, 95% confidence interval [CI], 1.50-3.64; TNFR2: HR 2.13, 95% CI 1.38-3.29) after adjustment for age, prior cardiovascular disease, predialysis systolic blood pressure, and large systolic blood pressure decline during dialysis session. For cardiovascular mortality, significance was only observed in TNFR1 (TNFR1: HR 2.15, 95% CI 1.13-4.10). Elevated TNFRs levels were associated with the risk of cardiovascular and/ or all-cause mortality independent of all relevant covariates in patients undergoing haemodialysis.