| MIA症候群為洗腎病患預測死亡率的重要預後因子 | |||||||||||||||||||||||||||||||
| 作者：Marlene Busko | |||||||||||||||||||||||||||||||
| 出處：WebMD醫學新聞 | |||||||||||||||||||||||||||||||
November 17, 2006（聖地牙哥訊）－同時有營養不良、發炎與心血管疾病，也就是所謂「MIA症候群」之洗腎病患，其死亡風險較高，這三種情況同時存在的情況下比單獨存在影響力高。 這項發現是來自一項收納817位洗腎病患的前瞻性研究結果，發表於美國腎臟醫學會（ASN）2006年腎臟週。 發表這項研究結果的紐西蘭Leiden大學醫院博士班學生Renee de Mutsert向Medscape表示，這項研究告訴我們主要的訊息是營養不良、發炎、心血管疾病各自與死亡率相關，但是如果病患同時有這三種情況，其死亡風險是非常高的，因此這三種情況之間是具有交互作用的。 雖然試驗中僅有少數病患罹患MIA症候群（6%），但這些病患皆於6年內死亡。 【營養不良、發炎、動脈硬化】 de Mutsert小姐向聽眾表示，洗腎病患常有營養不良、發炎與動脈硬化的情形，而且這些情況都與高死亡率有關；研究者最近假設這三種情況合併在一起構成一種所謂的MIA症候群（Stenvinkel P等人發表於Kidney Int. 1999;55:1899-911）；許多團隊已經檢驗個別危險因子與洗腎病患存活率之間的關係，但是結合這三種情況的MIA症候群是否會提升額外的風險，仍是未知的。 目前這項研究檢驗MIA症候群中各項情況之間的生物交互作用、以及一群剛開始洗腎的末期腎病變病患（ESRD）的死亡率；其中有來自紐西蘭透析適當性合作試驗（NECOSAD）已經完成MIA症候群中三種個別情況資料的817位病患（60%為男性、65%接受透析），病患平均年齡為59歲，最多後續追蹤達7年；MIA症候群中三種個別情況的定義分別是：營養不良為主觀整體評估7分中的1至5分，發炎的定義為C反應蛋白（CRP）濃度大於等於10 mg/dl，而心血管疾病則由醫師定義。 試驗開始時，38%病患沒有MIA症候群中的任一情況，其中10%病患有營養不良情形、11%病患有發炎情形、而14%有心血管疾病；僅有6%病患同時具有此三種情況；21%病患具有任兩種情況組合。 【死亡三重奏】 雖然每種情況各自與死亡率增加有關，但同時有MIA症候群的三種情況對於死亡率的影響是加乘的。 剛接受透析病患的7年死亡風險
試驗前每100位沒有MIA症候群任一情況的病患，有7位病患在一年內死亡；有其中一至兩種情況的病患風險較高；根據MIA症候群中單獨情況的死亡風險總和，研究者預期具有這三種情況的MIA症候群病患每年將會有30位死亡（HR為3.6）；但是，他們發現實際的數字更高，每年有45位這樣的病患死亡（HR為5.3）；de Mutsert小姐表示，因此，這些罹患MIA症候群病患，其中31%的死亡是與症候群中三種情形之間的生物交互作用有關。 新接受洗腎病患之死亡率、危險比與額外的危險因子
de Mutsert小姐的結論是，這項研究的意義在於提供洗腎病患罹患MIA症候群的證據，除此之外，具有高死亡風險的透析病患是可以被確認出來的。 | |||||||||||||||||||||||||||||||
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MIA Syndrome Strongly Predicts Mortality in Dialysis Patients By Marlene Busko November 17, 2006 (San Diego) — Having concurrent malnutrition, inflammation, and cardiovascular disease — the so-called "MIA syndrome" — identifies new dialysis patients who have an extremely high risk of dying, raising mortality risk over that seen with each component alone.
*Adjusted for age, sex, and hemodialysis/peritoneal dialysis. For every 100 patients with no components of the MIA syndrome at baseline, 7 patients died within a year. Having 1 or 2 components conferred moderate added risk. Based on the sum of the mortality risks of individual components, the researchers expected that the yearly mortality rate for patients with all 3 components (MIA syndrome) would be 30 patients a year (HR 3.6); instead, they found a rate of 45 patients a year (HR 5.3). "Thus, 31% of deaths among patients with the MIA syndrome were attributable to the biological interaction of the 3 components," Ms. de Mutsert said. Mortality Rate, Hazard Ratios, and Additive Risk in New Dialysis Patients
*Malnutrition, inflammation, or cardiovascular disease. "The implications of this research are that it provides prospective evidence for the existence of the MIA syndrome in dialysis patients, and that dialysis patients at extremely high risk of mortality can be identified," Ms. de Mutsert concluded. Renal Week 2006: ASN Annual Meeting: Abstract TH-FC125. These findings from a prospective study of 817 patients starting dialysis were presented in an oral session at the American Society of Nephrology (ASN) Renal Week 2006. Renée de Mutsert, a PhD student at Leiden University Hospital in the Netherlands, who presented the study here, told Medscape: "The main message is that all 3 components — malnutrition, inflammation, and cardiovascular disease — are independently associated with mortality, but if any patient has all 3 components of the MIA syndrome, their mortality risk is extremely high. So there is definitely an interaction among these 3 components." Although only a small proportion of the study patients had MIA syndrome (6%), these patients all died within 6 years. Malnutrition, Inflammation, Atherosclerosis Ms. de Mutsert told the audience that it is well known that malnutrition, inflammation, and atherosclerosis are highly prevalent in dialysis patients and that each condition is associated with an increased risk of dying. Researchers recently proposed that these 3 comorbid conditions constitute a pathophysiological syndrome called the "MIA syndrome" (Stenvinkel P et al. Kidney Int. 1999;55:1899-911). Many groups have examined the link between individual risk factors and survival of dialysis patients, but it was unknown whether the combination of all 3 components of the MIA syndrome conferred added risk. The current study examined the biological interaction between MIA syndrome components and mortality in a prospective cohort of patients with end-stage renal disease (ESRD) who were starting dialysis. It comprised 817 patients (60% men, 65% on hemodialysis) from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) trial who had complete data for the 3 MIA syndrome components. The patients, who had a mean age of 59 years at baseline, were followed for up to 7 years. The MIA components were defined as: malnutrition indicated by a subjective global assessment of 1 to 5 on a scale of 7, inflammation shown by C-reactive protein (CRP) > 10 mg/L, and cardiovascular disease diagnosed by a doctor. At baseline, 38% of patients had no MIA components, 10% had malnutrition, 11% had inflammation, and 14% had cardiovascular disease. Only 6% had all 3 components; 21% had combinations of 2 components. Deadly Trio Although each factor was independently linked with increased mortality, concurrently having all 3 components of the MIA syndrome increased the mortality risk strikingly more than expected based on having individual components. Risk of 7-Year Mortality in New Dialysis Patients |
