慢性肾脏病患者血清suPAR水平与颈动脉内膜中层厚度的相关性研究

摘要/Abstract

摘要： 目的：探讨慢性肾脏病（chronic kidney disease，CKD）患者血清可溶性尿激酶型纤溶酶原激活物受体（suPAR）水平与颈动脉内膜中层厚度（carotid intima-media thickness，CIMT）的相关性。方法：回顾性纳入2017年1月1日至2018年6月1日共155例CKD患者作为CKD组，另选45例健康体检者作为对照组，评估两组患者临床特征参数及生化指标的差异，分析CKD患者suPAR水平与生化指标相关性，并评估CKD患者CIMT增厚的发生率及其影响因素，利用受试者操作特征（receiver operating characteristic，ROC）曲线探讨suPAR水平预测CKD患者CIMT增厚的临床效能。结果：与对照组比较，CKD患者体质量指数（BMI）、低密度脂蛋白胆固醇（LDL-c）、总胆固醇（TC）、甘油三酯（TG）、收缩压、舒张压、糖化血红蛋白、超敏C-反应蛋白（hs-CRP）、尿酸、CIMT和suPAR均高于对照组，而eGFR低于对照组（P＜0.05）；Pearson相关分析显示，CKD患者suPAR水平与LDL-c、TC、TG、收缩压、hs-CRP、尿酸和CIMT水平均呈正相关性，与eGFR呈负相关性（P＜0.05）。CIMT超过0.8 mm的患者共69例，发生率为44.52%（69/155），单因素分析表明，LDL-c、收缩压、hs-CRP、尿酸、eGFR、suPAR水平在CIMT增厚组和正常组间差异均有统计学意义（P＜0.05）。Logistic 回归分析显示，suPAR升高是导致CKD患者CIMT增厚的危险因素，而eGFR升高是其保护因素(P＜0.05)。ROC曲线结果发现，suPAR（AUC：0.841）预测CKD患者CIMT增厚的临床效能较好，当截断值为8.9 μg·L-1时，敏感度和特异度分别为87.4%和90.7%。结论：CKD患者血清suPAR水平升高，可作为反映病情严重程度及预测患者CIMT增厚的一个临床指标。

Abstract: Objective：To investigate the association between serum level of suPAR and carotid intima-media thickness（CIMT） in patients with chronic kidney disease (CKD). Methods： A total of 155 patients with CKD and 45 health controls from Jan 1， 2017 to June 1， 2018 were retrospectively enrolled in this study. The differences of clinical characteristic parameters and biochemical indexes between patients with CKD and control group were evaluated and compared. The correlation between serum suPAR level and the above indications in CKD patients were analyzed by Pearson method. The incidence of CIMT more than 0.8 mm in patients with CKD and its potential influencing factors were also evaluated. The value of suPAR in predicting CIMT more than 0.8 mm in patients with CKD was analyzed by receiver operating characteristic (ROC) curve. Results： When compared with the control group， the BMI， LDL-c， TC， TG， systolic blood pressure， diastolic blood pressure， glycated hemoglobin， hs-CRP， uric acid， CIMT and suPAR levels were higher than those of the control group， while the levels of eGFR was lower than the control group (P<0.05). Pearson correlation analysis showed that serum suPAR level was positively correlated with LDL-c， TC， TG， systolic blood pressure， hs-CRP， uric acid and CIMT thickness but not with eGFR in CKD patients. All the differences were statistical significant. The incidence of CIMT more than 0.8 mm in patients with CKD was 44.52% (69/155). Univariate analysis showed that the levels of LDL-c， systolic blood pressure， hs-CRP， uric acid， eGFR and suPAR were different between the CIMT thickening group and the normal group (P<0.05). Logistic regression analysis showed that elevated suPAR level was a risk factor for CIMT thickening in CKD patients， while elevated eGFR level was a protective factor (P<0.05). The ROC curve results indicated that the value of suPAR (AUC：0.841) in predicting CIMT more than 0.8mm in patients with CKD was significant， with cut-off value， sensitivity and specificity was 8.9g·L-1， 87.4% and 90.7%， respectively. Conclusion： The serum suPAR level in CKD patients increased significantly， which can be used as a clinical index to reflect the severity of the disease and predict CIMT more than 0.8 mm.

黄艳玲,陈永华,袁利. 慢性肾脏病患者血清suPAR水平与颈动脉内膜中层厚度的相关性研究[J]. .

Huang YanLing,Cjen YongHua and Yuan Li. Association between Serum suPAR Level and Carotid Intima-media Thickness in Patients with Chronic Kidney Disease[J]. .

参考文献

1. Waters D D, Vogt L. Lipids, inflammation, and chronic kidney disease: aSHARP perspective[J]. Kidney International, 2018, 93(4):784-786.
2. Reciomayoral A, Banerjee D, Streather C, et al. Endothelial dysfunction, inflammation and atherosclerosis in chronic kidney disease--a cross-sectional study of predialysis, dialysis and kidney-transplantation patients.[J]. Atherosclerosis, 2011, 216(2):446-451.
3. Marco C, Pietro S, Annapaola Z, et al. Correlation between Inflammatory Markers of Atherosclerosis and Carotid Intima-Media Thickness in Obstructive, Sleep Apnea[J]. Molecules, 2014, 19(2):1651-1662.
4. Galliera E , Drago L , Marazzi M G , et al. Soluble urokinase-type plasminogen activator receptor (suPAR) as new biomarker of the prosthetic joint infection: Correlation with inflammatory cytokines[J]. Clinica Chimica Acta, 2015, 441:23-28.
5. Ichihara N, Miyamura M, Maeda D, et al. Association between serum soluble urokinase-type plasminogen activator receptor and atrial fibrillation[J]. Journal of Arrhythmia, 2017, 33(5):469-474.
6. Samman T A, Hayek S S, Sandesara P, et al. Circulating soluble urokinase plasminogen activator receptor levels and peripheral arterial disease outcomes[J]. Atherosclerosis, 2017, 264:108-114
7. Zoccali C, Pizzini P, Leonardis D. High soluble urokinase-type plasminogen activator receptor is a strong, independent predictor of the risk of worsening proteinuria and CKD pregression in stage 2-5 patients[J]. Nephrol Dial Transpl, 2016, 31:175-176.
8. 彭朝阳, 毛建华. 可溶性尿激酶型纤溶酶原激活物受体与足细胞病[J]. 中华儿科杂志, 2015, 53(2):146-148.
9. Kidney F N. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification[J]. Am J Kidney Dis, 2002, 39:S1-S266.
10. Lim CC,STeo BW,SOng PG, et al. Chronic kidney disease, cardiovascular disease and mortality: A prospective cohort study in a multi-ethnic Asian population[J]. European Journal of Preventive Cardiology, 2015, 22(8):1018-1026.
11. Angelantonio E D, Chowdhury R, Sarwar N, et al. Chronic kidney disease and risk of major cardiovascular disease and non-vascular mortality: prospective population based cohort study[J]. BMJ, 2010, 341(7776):768-768.
12. Major R W, Cheng M, Grant R A, et al. Cardiovascular disease risk factors in chronic kidney disease: A systematic review and meta-analysis[J]. Plos One, 2018, 13(3):e0192895.
13. Schulz C A, Persson M, Christensson A, et al. Soluble Urokinase-type Plasminogen Activator Receptor (suPAR) and Impaired Kidney Function in the Population-based Malmö Diet and Cancer Study[J]. Kidney International Reports, 2016, 2(2):239-247.
14. Eugen-Olsen J. suPAR-a future risk marker in bacteremia[J]. Journal of Internal Medicine, 2011, 270(1):29-31.
15. 王彦军, 朱琳, 俞天虹,等. 血浆suPAR水平与冠心病患者冠状动脉斑块稳定性、病变程度及冠心病预测之间的关系[J]. 中国动脉硬化杂志, 2015, 23(12):1236-1240.
16. Olson F J, Thurison T, Ryndel M, et al. Soluble urokinase-type plasminogen activator receptor forms in plasma as markers of atherosclerotic plaque vulnerability[J]. Clinical Biochemistry, 2010, 43(1-2):124-130.
17. 朱昭章, 桑晓红. 早中期慢性肾脏病患者颈动脉内中膜增厚及粥样斑块的危险因素研究[J]. 中国全科医学, 2010, 13(5):479-482.
18. Renata L, De M M B, Ceragioli O F L, et al. Evaluation of carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease[J]. J Pediatria, 2018.
19. Björn Meijers, Poesen R, Claes K, et al. Soluble urokinase receptor is a biomarker of cardiovascular disease in chronic kidney disease[J]. Kidney International, 2014, 87(1):210-216.
20. Rasmussen L J, Schultz M, Gaardsting A, et al. Inflammatory biomarkers and cancer: CRP and suPAR as markers of incident cancer in patients with serious non-specific symptoms and signs of cancer[J]. International Journal of Cancer, 2017, 141(1):191-199.

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