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Elevated Plasma Protein Carbonyl Level is a Major Risk Factor for Ischemic Heart Disease in Hemodialysis Patients
高濃度的血漿蛋白質酮基是血液透析病人缺血性心臟病主要的危險因子
摘要
背景：許多強而有利的證據已經證實氧化性的壓力，與動脈硬化致病性的形成有關聯。在維持性的血液透析病人中觀察到氧化性的壓力是加速心血管疾病產生的機制。此研究的目的，是要去探討是否為血液透析病人氧化性壓力的鑑別指標，同時在同樣條件下探討血漿蛋白質酮基濃度可否區別血液透析病人有無缺血性心肌病變。 方法：於個血液透析病人（三十個男性及五十二個女性，平均年齡為六十二歲）每週三或週四血液透析治療前收集血漿，藉由使用分光光譜儀器測定血漿蛋白質酮基的濃度。這些患者共四十二位，其中十六位男性及二十六位女性病人，臨床上有顯著的缺血性心肌病變。同時也測定八十二患者傳統的心血管危險因子，包括血清脂質、脂蛋白質、輔脂蛋白質及纖維蛋白原，血清生化學和透析量來比較。 結果：當與正敘對照組比較，血液透析病人平均血漿蛋白質酮基濃度明顯的提高。我們也發現患有缺血性心肌病變的血液透析病人血漿蛋白質酮基濃度明顯比那些無缺血性心肌病變患者高。血清脂蛋白質和血漿纖維蛋白原濃度在這二組族群沒有差異。高濃度的蛋白質酮基可能是患有缺血性心肌病變病患重要的預測值。 結論：我們的結果顯示，血液透析病人有高濃度的血漿蛋白質酮基濃度是易較於患有缺血性心肌病變。所以，在我們的血液透析病人，高濃度的血漿蛋白質酮基可當為缺血性心肌病變重要的預測值。在血液透析病人血漿蛋白質氧化損傷的增加，可能是由多次短暫的缺血-灌流所導致。這些發現更進一步證實，氧化性的壓力為缺血性心肌病變形成的危險因子。
並列摘要
Background: Compelling evidence has demonstrated a link between oxidative stress and the pathogenesis and progression of atherosclerosis It has been conjectured that oxidative stress may be a mechanism by which the accelerated rate of cardiovascular disease observed in maintenance hemodialysis (HD) patients, be explained. The purpose of this study was to examine the discriminative potential of plasma protein carbonyl (PC), a marker of oxidative stress, in age-, sex-, and smoking-matched HD patients with and without ischemic cardiomyopathy (ICM). Methods: Plasma protein carbonyls levels were determined using spectrophotometry in eighty-two HD patients (30 men and 52 women, mean age 62.3±11.8 years) immediately prior to one midweek HD treatment. Forty two patients, including 16 men and 26 women, had clinically significant ischemic cardiomyopathy. Traditional cardiovascular risk factors, including serum lipids, lipoproteins, apolipoproteins, and fibrinogen, were also measured, as were serum chemistry and dialysis adequacy. Results: Mean plasma protein levels were significantly elevated in HD patients when compared to normal controls. We also found that HD patients with 1CM have significantly elevated plasma protein carbonyls levels when compared to patients without 1CM. Serum lipoprotein and plasma fibrinogen levels did not differ between the two groups, therefore elevated PC levels appeared to be the single strongest predictor of prevalent ICM in this patient population. Conclusions: The results of our study suggest that ischemic cardiomyopathy is more prevalent among hemodialysis patients with higher plasma PC levels. Elevated plasma level of protein carbonyl was an important predictor of ischemic cardiomyopathy in our HD patients. The increased plasma proteins oxidation seen in HD patients may be the consequence of multiple brief episodes of ischemia-reperfusion. These findings provide further evidence for the role of oxidative stress as a risk factor for the occurrence and development of ICM.