Yoshihara Fumiki, Horio Takeshi, Nakamura Satoko, Yoshii Masayoshi, Ogata Chinami, Nakahama Hajime, Inenaga Takashi, Kangawa Kenji, Kawano Yuhei
Division of Hypertension and Nephrology, National Cardiovascular Center, National Cardiovascular Center Research Institute, Osaka, Japan.
Kidney Int. 2005 Sep;68(3):1355-63. doi: 10.1111/j.1523-1755.2005.00534.x.
Plasma adrenomedullin (AM) reflects cardiac dysfunction and predicts survival after myocardial infarction. The present study was designed to investigate whether the mature AM (mAM) reflects status of cardiac function, systemic blood volume, or inflammation in hemodialysis patients with cardiovascular disease, and whether mortality and additional cardiovascular morbidity can be predicted by mAM.
Plasma levels of mAM, atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), norepinephrine (NE), and C-reactive protein (CRP) before hemodialysis were measured in 67 chronic hemodialysis patients with cardiovascular disease, along with 2-dimensional and Doppler echocardiographic variables.
By univariate regression analysis, mAM correlated negatively with pulmonary venous flow velocity ratio and left ventricular (LV) ejection fraction and positively with LV inflow velocity ratio, LV end-diastolic, end-systolic volume indexes, plasma CRP level, and removal fluid volume by ultrafiltration. Multivariate stepwise regression analysis revealed that mAM reflected all variables better than log [ANP], log [BNP], and log [NE]. During a 1-year follow-up period, 7 patients died and 8 had additional cardiovascular events. Event-free Kaplan-Meier curves based on the median mAM (4.55 pmol/L) showed that patients with high plasma mAM levels had higher mortality and morbidity than those with low plasma mAM levels (P = 0.0056). By Cox multivariate proportional hazard analysis, mAM was related to mortality and morbidity [hazard ratio (HR) 4.55, 95% CI 1.2-16.8, P= 0.023).
Plasma mAM reflects cardiac dysfunction, excessive blood volume, and inflammation better than ANP, BNP, and NE, resulting in a predictor of mortality and cardiovascular morbidity in hemodialysis patients with cardiovascular disease.
血浆肾上腺髓质素（AM）反映心脏功能障碍并预测心肌梗死后的生存率。本研究旨在调查成熟AM（mAM）是否反映患有心血管疾病的血液透析患者的心脏功能状态、全身血容量或炎症，以及mAM是否可预测死亡率和额外的心血管发病率。
对67例患有心血管疾病的慢性血液透析患者在血液透析前测量血浆mAM、心房利钠肽（ANP）、B型利钠肽（BNP）、去甲肾上腺素（NE）和C反应蛋白（CRP）水平，以及二维和多普勒超声心动图变量。
通过单变量回归分析，mAM与肺静脉血流速度比值和左心室（LV）射血分数呈负相关，与LV流入速度比值、LV舒张末期、收缩末期容积指数、血浆CRP水平和超滤清除液量呈正相关。多变量逐步回归分析显示，mAM比log[ANP]、log[BNP]和log[NE]能更好地反映所有变量。在1年的随访期内，7例患者死亡，8例发生额外的心血管事件。基于mAM中位数（4.55 pmol/L）的无事件Kaplan-Meier曲线显示，血浆mAM水平高的患者比血浆mAM水平低的患者具有更高的死亡率和发病率（P = 0.0056）。通过Cox多变量比例风险分析，mAM与死亡率和发病率相关[风险比（HR）4.55，95%CI 1.2 - 16.8，P = 0.023]。
与ANP、BNP和NE相比，血浆mAM能更好地反映心脏功能障碍、血容量过多和炎症，是患有心血管疾病的血液透析患者死亡率和心血管发病率的预测指标。
