Serum C-reactive protein and nutritional parameters  in hemodialysis patients

Tamara Dragović; Mirjana M Mijušković; Brankica Terzić; Danijela Ristić Medić; Zoran Hajduković; Slavica Rađen

doi:10.2298/VSP160912155D

Tamara Dragović Military Medical Academy, Clinic of Endocrinology, Belgrade, Serbia
Mirjana M Mijušković University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Brankica Terzić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Danijela Ristić Medić University of Belgrade, Institute for Medical Research, Centre of Research Excellence in Nutritional and Metabolism, Belgrade, Serbia
Zoran Hajduković Military Medical Academy, Clinic of Endocrinology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Slavica Rađen Military Medical Academy, Clinic of Nephrology, Institute of Hygiene, Belgrade, Serbia;

DOI: https://doi.org/10.2298/VSP160912155D

Ključne reči: albumini, c-reaktivni protein, zapaljenje, nutritivni status, hemodijaliza

Sažetak

Apstrakt

Uvod/Cilj. Inflamacija je jedan od glavnih faktora odgovornih za nastanak vaskularnih komplikacija kod bolesnika sa terminalnom bubrežnom insuficijencijom. C reaktivni protein (CRP) se smatra senzitivnim markerom sistemske inflamacije, kao i faktorom koji doprinosi povećanom riziku od opšteg i kardiovaskularnog mortaliteta. Albumin je negativni protein akutne faze zapaljenja i njegova sinteza opada sa napredovanjem sistemske inflamacije. Za bolesnike na hemodijalizi poznato je da pate od visokog stepena proteinske malnutricije usled smanjene sinteze proteina i njihove pojačane razgradnje. Nizak nivo serumskog albumina kod tih bolesnika je posledica kompleksnog stanja koje podrazumeva sistemsku inflamaciju, malnutriciju i prekomernu hidrataciju. Cilj naše studije bio je da se ispita učestalost povišenog serumskog CRP-a u našoj populaciji dijaliznih bolesnika i da se utvrdi stepen njegove korelacije sa serumskim albuminom i drugim parametrima nutritivnog statusa. Metode. Ispitivanjem je obuhvaćeno 49 bolesnika na hroničnom programu hemodijalize u Centru za hemodijalizu Klinike za nefrologiju Vojnomedicinske akademije u Beogradu. Uzorci krvi za analizu uzimani su tokom punkcije arteriovenske fistule, a pre druge nedeljne hemodijalize. Određivanu su sledeći parametri: serumski nivo uree i kreatinina pre i posle procedure, CRP, hemoglobin, glikemija, ukupni holesterol, trigliceridi, glikozilirani hemoglobin (HbA1c), insulinemija i C-peptid pre hemodijalize. Rezultati. Od ukupno 49 dijaliznih bolesnika, bilo je 37 (75,5%) muškaraca i 12 (24,5%) žena, prosečne starosti 56,04 ± 13,93 godine. Dužina lečenja hemodijalizom je prosečno iznosila 7,37 ± 5 godina. Povišene vrednosti serumskog CRP-a (više od 3 mg/L) imalo je 65,3% bolesnika. U grupi bolesnika sa povišenim nivoom CRP-a u serumu, bilo je značajno više dijabetičara (n=12) u odnosu na grupu sa normalnim nivoom CRP-a u serumu (n = 3) (p ≤ 0,05). Uočili smo postojanje značajne pozitivne korelacije između serumskog CRP-a i serumske uree nakon dijaliznog procesa. U ispitivanoj grupi postojala je negativna korelacija između serumskog CRP-a i serumskog albumina, HbA1c, ukupnog holesterola i triglicerida. Ta korelacija nije bila statistički značajna. Zaključak. Naša studija je potvrdila visok stepen sistemske inflamacije kod dijaliznih bolesnika izražene kroz visoku učestalost povišenih vrednosti serumskog CRP-a. Negativna korelacija između nivoa serumskog CRP-a i serumskog albumina kao i drugih nutritivnih parametara, sugeriše da hronična inflamacija može biti ključna karika koja povezuje proteinsku malnutriciju sa visokim morbiditetom i mortalitetom ovih bolesnika.

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Serumski C-reaktivni protein i nutritivni parametri kod bolesnika na hemodijalizi

Sažetak

Reference