nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-1593Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESДегидроэпиандростерон сульфат у больных на программном гемодиализеDehydroepiandrosterone sulfate in hemodialysis patientsХрусталеваЕ. В.KhrustalevaE. V.noemail@neicon.ruМастыковВ. Э.MastikovV. E.noemail@neicon.ruШутовА. М.ShutovA. M.amshu@mail.ruВакинаТ. Н.VakinaT. N.noemail@neicon.ruПензенская областная клиническая больница им. Н.Н. Бурденко, г. Пенза; Ульяновская областная клиническая больница; Кафедра терапии и профессиональных болезней медицинского факультета Ульяновского государственного университета, г. УльяновскRussian Federation200523062025715963Copyright © Хрусталева Е.В., Мастыков В.Э., Шутов А.М., Вакина Т.Н., 20252025Хрусталева Е.В., Мастыков В.Э., Шутов А.М., Вакина Т.Н.Khrustaleva E.V., Mastikov V.E., Shutov A.M., Vakina T.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/1593

Цель. Дегидроэпиандростерон (ДЭА) и дегидроэпиандростерон сульфат (ДЭА-С) - стероидные гормоны, которые образуются в коре надпочечников. С низким уровнем ДЭА-С связывают целый ряд негативных биологических эффектов, включая нарушения иммунитета, депрессию, нарушения минерализации кости. Целью настоящего исследования явилось изучение содержания ДЭА-С у больных, находящихся на программном гемодиализе (ГД). Методы. Обследовано 124 больных (мужчин - 56, женщин - 68, средний возраст - 47 ± 12 лет), находящихся на лечении ГД. Контрольная группа состояла из 30 практически здоровых людей. Содержание ДЭА-С и кортизола в сыворотке крови исследовали иммуноферментным методом. Результаты. Средний уровень ДЭА-С у больных на ГД и в контрольной группе существенно не различался. Уровень ДЭА-С у мужчин был выше, чем у женщин: медиана - 5,7 (интерквартильный размах - ИКР - 3,9-9,8) и медиана - 2,6 (ИКР 1,3-4,2) мкмоль/л соответственно, p < 0,001. Наблюдалась отрицательная связь между возрастом и ДЭА-С (r = -0,36; p < 0,001), при этом мы не обнаружили связи между ДЭА-С и кортизолом в сыворотке крови (r = 0,1; p = 0,6). Многофакторный регрессионный анализ показал, что основными детерминантами содержания ДЭА-С в сыворотке крови были возраст и пол больных. Установлено также наличие независимой связи между уровнем альбумина сыворотки и уровнем ДЭА-С. Заключение. Таким образом, содержание ДЭА-С у больных на ГД зависит от пола и возраста. Мужчины имеют более высокий уровень гормона. Как у мужчин, так и у женщин содержание ДЭА-С снижается с возрастом. Низкий уровень ДЭА-С у больных на программном гемодиализе ассоциирован с гипоальбуминемией. Причинно-следственные связи между ДЭА-С и альбумином не ясны, однако не исключено, что негативный прогностический эффект гипоальбуминемии у диализных больных в определенной степени может реализоваться через низкое содержание ДЭА-С.

Aim. Dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S) are the major steroid hormones secreted by the adrenal gland. The secretion normally decreases with age. Administration of DHEA has been reported to have beneficial effects on diabetes and atherosclerosis. The aim of this study was to investigate serum level of DHEA-S in haemodialysis (HD) patients. Methods. 124 haemodialysis patients (56M, 68F, mean age 47 ± 12 years) who received bicarbonate HD 3 times a week were studied. The mean duration of a HD session was 4 hours. Control group consisted of 30 healthy persons. Serum level of DHEA-S and of cortisol was detected by IFA-assay. Results. The serum level of DHEA-S did not differ in the HD patients and control group. The serum level of DHEA-S in male patients was higher than that in females: median - 5,7 (IQR 3,9-9,8) vs median 2,6 (IQR 1,3-4,2) µmol/l, resp., p < 0,001). There was negative correlation between the serum DHEA-S and age (r = -0,36; p < 0,001). Cortisol did not differ in male and female: median - 468,0 (IQR 365,5-587,0) vs median - 443,0 (IQR 323,0-609,5) nmol/l, resp., p = 0,6). We did not detect a correlation between DHEA-S and cortisol level (r = 0,04; p = 0,7). Multiple regression analysis has shown that age, gender and serum albumin levels were independent predictors of serum DHEA-S. Conclusions. The gender and age are the main determinants of serum level of DHEAS in HD patients and low level of DHEA-S is associated with low serum albumin level. Relationship between DHEA-S and albumin is unknown, but it is possible that worse prognosis in HD patients with hypoalbuminemia can be partially associated with low DHEA-S level.

альбумингемодиализдегидроэпиандростерон сульфатхроническая почечная недостаточностьReferencesВакина Т.Н., Шутов А.М., Шалина С.В. и соавт. Дегидроэпиандростерон и половая функция у мужчин с хроническим простатитом. Урология 2003; 1: 49-52.Вакина Т.Н., Шутов А.М., Шалина С.В. и соавт. Дегидроэпиандростерон и половая функция у мужчин с хроническим простатитом. Урология 2003; 1: 49-52.Alexandersen P., Haarbo J., Christiansen C. The relationship of natural androgens to coronary heart disease in males: a review. Atherosclerosis 1996; 125: 1-13.Alexandersen P., Haarbo J., Christiansen C. The relationship of natural androgens to coronary heart disease in males: a review. Atherosclerosis 1996; 125: 1-13.Baulieu E.E. Dehydroepiandrosterone (DHEA): fountain of youth? J Clin Endocrinol Metab 1996; 81: 3141-3151.Baulieu E.E. Dehydroepiandrosterone (DHEA): fountain of youth? J Clin Endocrinol Metab 1996; 81: 3141-3151.Beishuizen A., Thijs L.G., Vermes I. et al. Decreased levels of dehydroepiandrosterone sulphate in severe critical illness: a sign of exhausted adrenal reserve? Crit Care 2002; 6: 434-438.Beishuizen A., Thijs L.G., Vermes I. et al. Decreased levels of dehydroepiandrosterone sulphate in severe critical illness: a sign of exhausted adrenal reserve? Crit Care 2002; 6: 434-438.Bologa R.M., Levine D.M., Parker T.S. et al. Interleukin-6 predicts hypoalbuminemia, hypocholesterolemia, and mortality in hemodialysis patients. Am J Kidney Dis 1998; 32: 107-114.Bologa R.M., Levine D.M., Parker T.S. et al. Interleukin-6 predicts hypoalbuminemia, hypocholesterolemia, and mortality in hemodialysis patients. Am J Kidney Dis 1998; 32: 107-114.Campion E.W., deLabry L.O., Glinn R.J. The effect of age on serum albumin in healthy males: Report from the Normative Aging Study. J Gerontol 1998; 43: M18-M20.Campion E.W., deLabry L.O., Glinn R.J. The effect of age on serum albumin in healthy males: Report from the Normative Aging Study. J Gerontol 1998; 43: M18-M20.Catania R.A., Angele M.K., Ayala A. et al. Dehydroepiandrosterone restores immune function following trauma-haemorrhage by a direct effect on T lymphocytes. Cytokine 1999; 11: 443-450.Catania R.A., Angele M.K., Ayala A. et al. Dehydroepiandrosterone restores immune function following trauma-haemorrhage by a direct effect on T lymphocytes. Cytokine 1999; 11: 443-450.Ferrari E., Casarotti D., Mussoni B. et al. Age-related changes of the adrenal secretory pattern: possible role in pathological brain aging. Brain Res Rev 2001; 37: 294-300.Ferrari E., Casarotti D., Mussoni B. et al. Age-related changes of the adrenal secretory pattern: possible role in pathological brain aging. Brain Res Rev 2001; 37: 294-300.Freiss E., Schiftelholz T., Steckler T., Steiger A. Dehydroepiandrosterone - a new neurosteroid. European Journal of Clinical Investigation 2000; 30 (Suppl. 3): 46-50.Freiss E., Schiftelholz T., Steckler T., Steiger A. Dehydroepiandrosterone - a new neurosteroid. European Journal of Clinical Investigation 2000; 30 (Suppl. 3): 46-50.Greenblatt D.J. Reduced serum albumin concentration in the elderly; A report from the Boston Collaborative Drug Surveillance Program. J Am Geriatr Soc 1979; 27: 20-22.Greenblatt D.J. Reduced serum albumin concentration in the elderly; A report from the Boston Collaborative Drug Surveillance Program. J Am Geriatr Soc 1979; 27: 20-22.High K.P. Infection as a cause of age-related morbidity and mortality. Aging Res Rev 2004; 3: 1-14.High K.P. Infection as a cause of age-related morbidity and mortality. Aging Res Rev 2004; 3: 1-14.Iseki K., Tozawa M., Yoshi S. et al. Serum creatinine protein (CRP) and risk of death in chronic dialysis patients. Nephrol Dial Transplant 1999; 14: 1956-1960.Iseki K., Tozawa M., Yoshi S. et al. Serum creatinine protein (CRP) and risk of death in chronic dialysis patients. Nephrol Dial Transplant 1999; 14: 1956-1960.Kato A., Odamaki M., Takita T. et al. Association between interleukin-6 and carotid atherosclerosis in hemodialysis patients. Kidney Int 2003; 61: 1143-1152.Kato A., Odamaki M., Takita T. et al. Association between interleukin-6 and carotid atherosclerosis in hemodialysis patients. Kidney Int 2003; 61: 1143-1152.Kaysen G.A. Serum albumin concentration in dialysis patients: Why does it remain resistant to therapy? Kidney Int 2003; 64 (Suppl. 87): S92-S98.Kaysen G.A. Serum albumin concentration in dialysis patients: Why does it remain resistant to therapy? Kidney Int 2003; 64 (Suppl. 87): S92-S98.Labrie F., Belanger A., Cusan L. et al. Marked decline in serum concentrations of adrenal C19 sex steroid precursors and conjugated androgen metabolites during aging. J Clin Endocrinol Metab 1997; 82: 2396-2402.Labrie F., Belanger A., Cusan L. et al. Marked decline in serum concentrations of adrenal C19 sex steroid precursors and conjugated androgen metabolites during aging. J Clin Endocrinol Metab 1997; 82: 2396-2402.Longcope C. Dehydroepiandrosterone metabolism. J Endocrinol 1996; 150: 125-127.Longcope C. Dehydroepiandrosterone metabolism. J Endocrinol 1996; 150: 125-127.Lopes A.A., Bragg J., Young E. et al. Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe. Kidney Int 2002; 62: 199-207.Lopes A.A., Bragg J., Young E. et al. Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe. Kidney Int 2002; 62: 199-207.Lowrie E.G., Lew N.L. Death risk in hemodialysis patients: The predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990; 15: 458-482.Lowrie E.G., Lew N.L. Death risk in hemodialysis patients: The predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990; 15: 458-482.Orentreich N., Brind J.L., Rizer R.L., Vogelman J.H. Age changes and sex differences in serum dehydroepiandrosterone sulfate concentrations throughout adulthood. J Clin Endocrinil Metab 1984; 59: 551-555.Orentreich N., Brind J.L., Rizer R.L., Vogelman J.H. Age changes and sex differences in serum dehydroepiandrosterone sulfate concentrations throughout adulthood. J Clin Endocrinil Metab 1984; 59: 551-555.Orentreich N., Brind J.L., Vogelman J.N. et al. Long-term longitudinal measurements of plasma dehydroepiandrosterone sulfate in normal men. J Clin Endocrinol Metab 1992; 75: 1002-1004.Orentreich N., Brind J.L., Vogelman J.N. et al. Long-term longitudinal measurements of plasma dehydroepiandrosterone sulfate in normal men. J Clin Endocrinol Metab 1992; 75: 1002-1004.Ridker P.M., Buring J.E., Shin J. et al. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 1998; 98: 731-733.Ridker P.M., Buring J.E., Shin J. et al. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 1998; 98: 731-733.Rosenfeld R.S., Hellman L., Gallagher T.F. Metabolism and interconversion of dehydroisoandrosteron and dehydroisoandrosteron sulfate. J Clin Endocrinol Metab 1972; 35: 187-193.Rosenfeld R.S., Hellman L., Gallagher T.F. Metabolism and interconversion of dehydroisoandrosteron and dehydroisoandrosteron sulfate. J Clin Endocrinol Metab 1972; 35: 187-193.Steinman T.I. Serum albumin: Its significance in patients with ESRD. Seminar in Dialysis 2000; 13: 404-408.Steinman T.I. Serum albumin: Its significance in patients with ESRD. Seminar in Dialysis 2000; 13: 404-408.Stenvinkel P., Heimbürger O., Jogestrand T. Elevated interleukin-6 predicts progressive carotid artery atherosclerosis in dialysis patients: Association with Chlamidia pneumoniae seropositivity. Am J Kidney Dis 2002; 39: 274-282.Stenvinkel P., Heimbürger O., Jogestrand T. Elevated interleukin-6 predicts progressive carotid artery atherosclerosis in dialysis patients: Association with Chlamidia pneumoniae seropositivity. Am J Kidney Dis 2002; 39: 274-282.Stenvinkel P., Heimbürger O., Lindholm B. et al. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 2000; 15: 953-960.Stenvinkel P., Heimbürger O., Lindholm B. et al. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 2000; 15: 953-960.Straub R.H., Konecna L., Hrach S. et al. Serum dehydroepiandrosterone (DHEA) and DHEA sulfate are negatively correlated with serum interleukin-6, and DHEA inhibits IL-6 secretion from mononuclear cells in men. J Clin Endocrinol Metab 1998; 83: 2012-1017.Straub R.H., Konecna L., Hrach S. et al. Serum dehydroepiandrosterone (DHEA) and DHEA sulfate are negatively correlated with serum interleukin-6, and DHEA inhibits IL-6 secretion from mononuclear cells in men. J Clin Endocrinol Metab 1998; 83: 2012-1017.Sulcova J., Hill M., Hampl R., Starka L. Age and sex related differences in serum levels of unconjugated dehydroepiandrosterone and its sulphate in normal subjects. J Endocrinol 1997; 154: 57-62.Sulcova J., Hill M., Hampl R., Starka L. Age and sex related differences in serum levels of unconjugated dehydroepiandrosterone and its sulphate in normal subjects. J Endocrinol 1997; 154: 57-62.Tchernof A., Labrie F. Dehydroepiandrosterone, obesity and cardiovascular disease risk: a review of human studies. Eur J Endocrinol 2004; 151: 1-14.Tchernof A., Labrie F. Dehydroepiandrosterone, obesity and cardiovascular disease risk: a review of human studies. Eur J Endocrinol 2004; 151: 1-14.Tok E.C., Ertunc D., Oz U. et al. The effect of circulating androgens on borne mineral density in postmenopausal women. Maturitas 2004; 48: 235-242.Tok E.C., Ertunc D., Oz U. et al. The effect of circulating androgens on borne mineral density in postmenopausal women. Maturitas 2004; 48: 235-242.Wolkowitz O.M., Reus V.I., Roberts E. et al. Dehydroepiandrosterone treatment in depression. Biol Psychiatry 1997; 41: 311-318.Wolkowitz O.M., Reus V.I., Roberts E. et al. Dehydroepiandrosterone treatment in depression. Biol Psychiatry 1997; 41: 311-318.Wong C.S., Hingorani S., Gillen D.L. et al. Hypoalbuminemia and risk of death in pediatric patients with end-stage renal disease. Kidney Int 2002; 61: 630-637.Wong C.S., Hingorani S., Gillen D.L. et al. Hypoalbuminemia and risk of death in pediatric patients with end-stage renal disease. Kidney Int 2002; 61: 630-637.Yeun J.Y., Levine R.A., Mantadilok V., Kaysen G.A. C-reactive protein predicts all cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis 2000; 35: 469-476.Yeun J.Y., Levine R.A., Mantadilok V., Kaysen G.A. C-reactive protein predicts all cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis 2000; 35: 469-476.Young D.G., Skibinski G., Mason J.I., James K. The influence of age and gender on serum dehydroepiandrosterone sulphate (DHEA-S), IL-6, IL-6 soluble receptor (IL-6sR) and transforming growth factor beta 1 (TGF-â1) levels in normal healthy blood donors. Clin Exp Immunol 1999; 117: 476-481.Young D.G., Skibinski G., Mason J.I., James K. The influence of age and gender on serum dehydroepiandrosterone sulphate (DHEA-S), IL-6, IL-6 soluble receptor (IL-6sR) and transforming growth factor beta 1 (TGF-â1) levels in normal healthy blood donors. Clin Exp Immunol 1999; 117: 476-481.Zimmermann J., Herrlinger S., Pruy A. et al. Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 1999; 55: 648-658.Zimmermann J., Herrlinger S., Pruy A. et al. Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 1999; 55: 648-658.

The authors declare that there are no conflicts of interest present.