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By  Asuka AOKI,  Kan KIKUCHI,  Misao TSUKADA,  Takashi AKIBA and  Kosaku NITTA


〔目的〕内臓脂肪より分泌されるアディポネクチンは抗動脈硬化作用を有する.透析患者では健常者と比較しアディポネクチンは高値であるが,動脈硬化は進行しており心血管疾患が死因の上位を占める.そこで,透析患者の動脈硬化とアディポネクチンとの関連について検討した.〔方法〕当院で慢性透折中の男性25名,女性24名,年齢54.3±13.8歳,透析歴12.4±9.6年の患者を対象とした.対象者に空腹時採血を施行し,動脈硬化検査として上腕-足首間の脈波速度(baPWV)を測定した.〔結果〕単回帰分析でbaPWVとアディポネクチンは,r=-0.43,p=0.003と有意な負の相関を認めた.ステップワイズ重回帰分析で,baPWVに対する重要な因子はアディポネクチンと年齢であった.アディポネクチン値で3分位し,1年後のbaPWV変化を比較した場合,低値群で有意なbaPWVの上昇を認めた.〔考察〕透析患者のアディポネクチンは高値であるが動脈硬化性疾患による死亡は高く,アディポネクチンが動脈硬化に関与するか不明であった.動脈硬化のマーカーであるbaPWVとアディポネクチンは有意な負の相関があり,アディポネクチン低値の患者では1年後のbaPWVが有意に上昇した.健常者と同様に透析患者でも,アディポネクチンが動脈硬化に関与する重要な因子であることが示された.〔結論〕透析患者においても,アディポネクチンが動脈硬化の進展に影響を与える重要な因子である.Atherosclerosis is a serious complication in patients undergoing chronic hemodialysis. The serum levels of adiponectin to the risk of development of arterial sclerosis and its treatment have not yet been fully clarified in hemodialysis patients. The present study was undertaken to examine the relationship between atherosclerosis and the serum levels of adiponectin in hemodialysis patients. The subjects were 25 males and 24 females who had been undergoing chronic hemodialysis at our facility. Simple regression analysis revealed a significantly negative correlation between the brachial ankle pulse wave velocity (baPWV) and the serum adiponectin level (r = -0.43, p = 0.003). Stepwise multiple regression analysis revealed the serum adiponectin level and age as major factors determining the baPWV. To analyze the relationship between the serum levels of adiponectin and various parameters of atherosclerosis, the serum adiponectin levels in the patients were divided into tertiles, low group, medium group, and high group. Observation of the changes of the baPWV over one year revealed that the value increased significantly in the low group as compared with that in the patients with values in the high group and medium group. Development of cardiovascular disease was observed only in the patients with serum adiponectin levels in the low group. The results of this study indicate that serum adiponectin are important factors determining the rate of progression of atherosclerosis in chronic hemodialysis patients

Topics: hemodialysis, adiponectin, atherosclerosis, pulse wave velocity
Publisher: 東京女子医科大学学会
Year: 2008
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