The metabolic syndrome as a risk factor for chronic kidney disease: More than a fat chance?
The metabolic syndrome as a risk factor for chronic kidney disease: More than a fat chance?
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DOI：
10.1097/01.asn.0000141964.68839.bb
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发表时间：
2004-11-01
影响因子：
13.6
通讯作者：
Sedor, JR
中科院分区：
文献类型：
--
作者：
Schelling, JR;Sedor, JR
代谢综合征，也称为X综合征或胰岛素抵抗综合征，其特征在于腹部肥胖、高血糖症、高血压、高胆固醇血症和HDL胆固醇降低。在本期《美国肾脏病学会杂志》中，Wisse（1）描述了内脏脂肪慢性炎症与胰岛素抵抗和代谢综合征特征的病理特征之间的联系。由于目前肥胖和糖尿病的流行，美国代谢综合征的患病率为1.47亿，并且还在上升（2）。《美国肾脏病学会杂志》的读者都很清楚，慢性肾脏病（CKD）也越来越常见，在美国估计有800万人的GFR< 60 ml/min（第三次全国健康和营养检查调查）。代谢综合征表型的许多方面与CKD相关，这表明内脏型肥胖的个体肾功能进行性丧失的风险增加。Hoehner等人(3)在一项对来自威斯康星州和明尼苏达州的美洲印第安人的横断面研究中，分层后，与对照组相比，具有三个或更多代谢综合征特征的个体发生微量白蛋白尿的几率增加了2.3倍。Palaniappan等人(4)和Chen等人(5)从第三次全国健康和营养检查调查数据库中提取数据，该数据库包含来自> 6000名受试者的详细临床信息。两项研究都发现代谢综合征和微量白蛋白尿之间存在统计学关联。Chen等人还发现代谢综合征因素的数量与GFR< 60 ml/min之间存在显著相关性。导致最大风险的个体特征是高血压和高血糖症（5），这并不奇怪，因为这两种因素都易导致CKD发病和/或进展（6，7）。
The metabolic syndrome, also known as syndrome X or insulin resistance syndrome, is characterized by abdominal obesity, hyperglycemia, hypertension, hypertriglyceridemia, and reduced HDL cholesterol. In this issue of the Journal of the American Society of Nephrology, Wisse (1) describes the link between chronic inflammation of visceral adipose and the insulin resistance and pathologic features that characterize the metabolic syndrome. The prevalence of the metabolic syndrome in the United States is∼ 47 million and rising (2), as a result of the current obesity and diabetes epidemics. Journal of the American Society of Nephrology readers are well aware that chronic kidney disease (CKD) is also increasingly common, with an estimated 8 million people in the United States with GFR< 60 ml/min (Third National Health and Nutrition Examination Survey). Many aspects of the metabolic syndrome phenotype are associated with CKD, suggesting that individuals with visceral obesity are at increased risk for progressive loss of renal function.Several groups have examined the relationship between the metabolic syndrome and CKD. Hoehner et al.(3) correlated the metabolic syndrome profile and microalbuminuria in a cross-sectional study of American Indians from Wisconsin and Minnesota. After stratification, individuals with three or more metabolic syndrome traits had a 2.3-fold increased odds of having microalbuminuria compared with a control group without the syndrome. Palaniappan et al.(4) and Chen et al.(5) extracted data from the Third National Health and Nutrition Examination Survey database, which contains detailed clinical information from> 6000 subjects. Both studies found a statistical association between metabolic syndrome and microalbuminuria. Chen et al. also discovered a significant correlation between number of metabolic syndrome factors and GFR< 60 ml/min. Individual traits that confer greatest risk were hypertension and hyperglycemia (5), which is not surprising, because both factors predispose to CKD pathogenesis and/or progression (6, 7).