- 學位論文
在非糖尿病引起之慢性腎臟病中Adiponectin和代謝症候群與腎臟預後的關聯性
The Association of Adiponectin with Metabolic Syndrome and Renal Outcome in Patients with Non-diabetic Chronic Kidney Disease
摘要
研究背景 Adiponectin是血液中含量最多的脂肪細胞激素(Adipokine)，其本身具有增加胰島素敏感性和抗發炎反應的特性。然而，在慢性腎臟病(CKD)族群的血液中，adiponectin會因為腎臟清除率降低，調節慢性腎臟病生理機制的代償反應，或者adiponectin阻抗性等等原因而上升。因此，這篇研究目的在於觀察在非糖尿病相關之腎臟病病人中，考慮到身體組成成分及代謝症候群，血中adiponectin和進展到末期腎臟病(ESRD)的關聯性。 研究方法 這篇觀察性研究從2010年到2017年，共蒐集了194位非糖尿病相關之腎臟病病人，其腎絲球過濾率(eGFR)介於10到60 ml/min/1.73 m2，利用MILLIPLEX MAP Human Serum Adipokine Panel A kit (Millipore, Billerica, MA)檢驗血中adiponectin濃度，並根據濃度將病人分組成三分位(tertile)，就其結果進行相關統計及分析。 結果 在平均五年之追蹤期間，共47位(24.2%)的病人進展到末期腎臟病。Adiponectin血中濃度中位數為29.4μg/ml (interquartile range, 13.3-108.7)。我們發現adiponectin濃度和身體質量指數(BMI) (r = -0.29; P < 0.001)及腰圍(r = -0.35; P < 0.001)呈負相關。經過分層Cox迴歸模式分析後，adiponectin進展到末期腎臟病之風險比(hazard ratio)為3.41 (95% CI, 1.56 to 7.46; P=0.002)。且次組別分析中，未發現和adiponectin有交互作用的情形。 結論 總而言之，在非糖尿病相關之慢性腎臟病的病人中，即使考慮了傳統的風險因子後，血液中較高的adiponectin仍有較高的獨立風險會進展到末期腎臟病。未來仍需要其他研究來證實因果關係，證實降低adiponectin後是否可減緩慢性腎臟病的進展。
並列摘要
Background Adiponectin is the most abundant circulating adipokine which possesses insulin-sensitizing and anti-inflammatory properties. However, elevated adiponectin associated with kidney function declines are attributed to decreased clearance, compensatory response or adiponectin resistance. Therefore, the aim of this study is to examine the association between serum adiponectin and end-stage renal disease (ESRD) risk in those with non-diabetic chronic kidney disease (CKD) accounted for differences in body composition and metabolic syndrome components. Methods This was an observational study from 2010 to 2017. We enrolled 194 non-diabetic CKD patients with a eGFR range of between 10 and 60 ml/min/1.73 m2, who were categorized into tertiles based on serum adiponectin concentration. Adiponectin were measured using the MILLIPLEX MAP Human Serum Adipokine Panel A kit (Millipore, Billerica, MA). The primary end point was defined as renal failure requiring renal replacement therapy. Results During a mean follow-up of 5 years, 47(24.2%) incident cases of ESRD were observed. The mean eGFR was 30.0 ± 12.7 mL/min/1.73m2. The baseline median adiponectin concentration in the cohort was 29.4μg/ml (interquartile range, 13.3-108.7). Adiponectin levels were inversely related to BMI (r = -0.29; P < 0.001) and waist circumference (r = -0.35; P < 0.001). In fully adjusted Cox regression model, hazard ratio (HR) for ESRD was 3.41 (95% CI, 1.56 to 7.46; P = 0.002). Besides, we did not detect effect modification between different subgroups. Conclusions In conclusion, higher adiponectin was associated with higher risk for ESRD independent of conventional risk factors in patients with non-diabetic CKD, including metabolic syndrome or body composition.
參考文獻
延伸閱讀
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