(1–3)-β-D glucans (BG) are cellular components of yeasts and fungi. Elevated blood levels may be an adjunct in diagnosing invasive fungal infection, though can be high in dialysis patients without fungaemia. BG can also induce false positive signals in endotoxin detection assays (Limulus Amoebocyte Lysate [LAL] assay). We explored the relationship between BG levels, renal impairment, endotoxaemia and inflammation. We measured serum BG levels, markers of inflammation and blood endotoxin levels in 20 controls, 20 with stages 1–3 chronic kidney disease (CKD), 20 with stages 4–5 CKD, 15 on peritoneal dialysis (PD) and 60 on haemodialysis (HD). Another 30 patients were studied before and after HD initiation. BG levels increased with advancing CKD, being highest in HD patients, 22% of whom had elevated levels (> 80 pg/ml). Levels increased significantly following HD initiation. Levels also correlated positively with CRP, TNFα, IL-6 levels, independently of CKD stage. Blood endotoxin was detectable by LAL assays in 10–53% of the CKD cohort, being most prevalent in the HD group, and correlating positively with BG levels. Adding BG blocking agent to the assay reduced endotoxin detection confining it to only 5% of HD patients. Levels of inflammatory markers were higher in those with detectable endotoxin - whether false- or true positives. BG levels increased with decreasing renal function, being highest in dialysis patients. High BG levels were associated with false positive blood endotoxin signals, and with markers of inflammation, independently of CKD stage. The cause for high BG levels is unknown but could reflect increased gut permeability and altered mononuclear phagocytic system function.

中文翻译：

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晚期 CKD 中的 β-葡聚糖：在内毒素血症和炎症中的作用

(1–3)-β-D 葡聚糖 (BG) 是酵母和真菌的细胞成分。血液水平升高可能是诊断侵袭性真菌感染的辅助手段，但在没有真菌血症的透析患者中​​可能会升高。BG 还可以在内毒素检测测定（鲎变形细胞裂解物 [LAL] 测定）中诱导假阳性信号。我们探讨了 BG 水平、肾功能损害、内毒素血症和炎症之间的关系。我们测量了 20 名对照组的血清 BG 水平、炎症标志物和血液内毒素水平，其中 20 名患有 1-3 期慢性肾病 (CKD)，20 名患有 4-5 期 CKD，15 名接受腹膜透析 (PD)，60 名接受血液透析。高清）。在 HD 开始之前和之后对另外 30 名患者进行了研究。BG 水平随着 CKD 的进展而增加，在 HD 患者中最高，其中 22% 的患者水平升高（> 80 pg/ml）。HD 开始后水平显着增加。水平还与 CRP、TNFα、IL-6 水平呈正相关，与 CKD 分期无关。在 10-53% 的 CKD 队列中，LAL 检测可检测到血液内毒素，在 HD 组中最为普遍，并且与 BG 水平呈正相关。在测定中添加 BG 阻断剂减少了内毒素检测，使其仅适用于 5% 的 HD 患者。具有可检测内毒素的炎症标志物水平较高 - 无论是假阳性还是真阳性。BG 水平随着肾功能的下降而增加，在透析患者中​​最高。高 BG 水平与假阳性血液内毒素信号和炎症标志物相关，与 CKD 分期无关。