胰酶作为慢性肾脏病3-5期非透析患者代谢紊乱标志物的潜力
Journal: Basic Medical Theory Research DOI: 10.12238/bmtr.v7i5.16503
Abstract
慢性肾脏病(chronic kidney disease,CKD)3-5期非透析患者常常面临一系列复杂的代谢紊乱问题,这些问题不仅限于肾脏本身,还涉及全身多个系统。胰酶(pancreatic enzymes)在慢性肾脏病(CKD)患者代谢紊乱中的潜在标志物作用是一个新兴的研究方向。胰酶传统上被用于评估消化系统的功能,尤其是在诊断胰腺疾病时。然而,近年来的研究开始揭示,胰酶在CKD患者的代谢异常(如蛋白质能量消耗、炎症和营养不良)中可能具有重要的生物标志物潜力。代谢异常不仅影响患者的生活质量,还增加了心血管疾病、感染和其他并发症的风险,最终影响患者的生存率。本综述系统分析胰酶在CKD患者代谢紊乱中的潜在机制、临床关联及作为新型生物标志物的可行性,并探讨未来研究方向。
Keywords
慢性肾脏病；胰酶；淀粉酶；脂肪酶；代谢紊乱；生物标志物
Funding
青海省人民医院院内科研项目(2024-qhsrmyy-27)。
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[3] 上海市肾内科临床质量控制中心专家组.慢性肾脏病早期筛查、诊断及防治指南(2022年版)[J].中华肾脏病杂志,2022, 38(05):453-464.
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[5] Speyer E,Tu C,Zee J,et al. Symptom burden and its impa ct onquality of life in patients with moderate to severe CKD: TheInternational Chronic Kidney Disease Outcomes and Practi cePatterns Study(CKDopps)[J].Am J Kidney Dis,2024,84(6):696 -707.e69.
[6] 王丽,张改华,饶向荣.295例慢性肾脏病患者高胰酶血症相关因素分析[J].中国中西医结合肾病杂志,2010,11(09):815-816.
[7] 中国医师协会肾脏内科医师分会.中国慢性肾脏病营养治疗临床实践指南(2021版)[J].中华医学杂志,2021,101(8):539-559.
[8] Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P,Cuppari L,Franch H,Guarnieri G, Ikizler TA, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Treviño-Becerra A, Wanner C. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int.2008 Feb;73(4):391-8.
[9] Pina AF, Borges DO, Meneses MJ, Branco P, Birne R, Vilasi A, Macedo MP. Insulin: Trigger and Target of Renal Functions. Front Cell Dev Biol. 2020 Jul 29;8:519.
[10] Mok,K.Y.,Chan,P.F.,Lai,L.K.P.et al.Prevalence of diabetic nephropathy among Chinese patients with type 2 diabetes mellitus and different categories of their estimated glomer ular filtration rate based on the Chronic Kidney Disease Epide miology Collaboration (CKD-EPI) equation in primary care in Hong Kong: a cross-sectional study. J Diabetes Metab Disord 18,281-288(2019).
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[12] Mitrofanova A., Merscher S., Fornoni A. Kidney lipid dysmetabolism and lipid droplet accumulation in chronic kidn ey disease.Nat.Rev.Nephrol.2023;19:629-645.
[13] Zhu Z.,Hu J.,Chen Z.,Feng J., Yang X., Liang W., Ding G. Transition of acute kidney injury to chronic kidney disease: Role of metabolic reprogramming. Metabolism. 2022;131:1551 94.
[14] Santos A.L.,Preta G.Lipids in the cell:Organisation regulates function. Cell.Mol. Life Sci.2018;75:1909-1927.
[15] Panov A.,Mayorov V.I.,Dikalov S.Metabolic syndrome and β-oxidation of long-chain fatty acids in the brain, heart, and kidney mitochondria.Int.J.Mol.Sci.2022;23:4047.
[16] Forbes J.M.,Thorburn D.R. Mitochondrial dysfunction in diabetic kidney disease.Nat.Rev.Nephrol.2018;14:291-312.
[17] Scholz H., Boivin F.J., Schmidt-Ott K.M., Bachmann S., Eckardt K.-U., Scholl U.I., Persson P.B. Kidney physiology and susceptibility to acute kidney injury:Implications for renopr otection.Nat.Rev.Nephrol.2021;17:335-349.
[18] 上海慢性肾脏病早发现及规范化诊治与示范项目专家组,高翔,梅长林.慢性肾脏病筛查诊断及防治指南[J].中国实用内科杂志,2017,37(01):28-34.
[19] Rodrigues Bacci M.Chronic kidney disease and dysbios is:An overview of gut microbiota and uremic toxins.Clin Neph rol.2025Apr;103(4):243-250.
[20] Graboski AL,Redinbo MR(2020)Gut-derived proteinbound uremic toxins.Toxins (Basel)12(9):590.
[21] Plata C,Cruz C, Cervantes LG, Ramirez V (2019) The gut microbiota and its relationship with chronic kidney disease. Int Urol Nephrol 51(12):2209-2226.
[22] Ramos CI,Armani RG, Canziani MEF, Dalboni MA, Dolenga CJR, Nakao LS,Campbell KL, Cuppari L (2019) Effect of prebiotic(fructooligosaccharide) on uremic toxins of chronic kidney disease patients: a randomized controlled trial. Nephrol Dial Transplant 34(11):1876-1884.
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[24] E P,J C,HI F,et al.慢性肾脏病中的炎症和动脉硬化:慢性肾功能不全队列研究中的发现[J].中华高血压杂志,2017,25(11):1098.
[25] 刘付敬樟,文丽斯,何赖长,等.慢性肾功能不全非透析患者血清胰酶与炎症反应、营养状态的相关性分析[J].中国实用医药,2019,14(10):52-54.
[26] Development and validation of dynamic clinical subph enotypes in acute pancreatitis patients using vital sign trajectories in intensive care units: A multinational cohort study.(2025).Signal Transduction and Targeted Therapy,10(1),180.
[27] Amabile N, Guérin AP, Leroyer A, Mallat Z, Nguyen C, Boddaert J, London GM, Tedgui A, Boulanger CM. Circulating end othelial microparticles are associated with vascular dysfunct ion in patients with end-stage renal failure. J Am Soc Nephr ol.2005 Nov;16(11):3381-8.
[28] Motojima M, Hosokawa A,Yamato H, et al. Uremic toxins of organic anions up-regulate PAI-1 expression by induction of NF-κB and free radical in proximal tubular cells[J].Kidn ey Int,2003,63:1671-1680.
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