Zoccali C, Mallamaci F, Tripepi G, Cutrupi S, Pizzini P, Malatino L
CNR-IBIM, Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension & Division of Nephrology, Dialysis and Transplantation, Reggio Calabria, Italy.
Kidney Int. 2006 Apr;69(7):1253-8. doi: 10.1038/sj.ki.5000114.
Urotensin II (UTN) is a vasoactive substance that may induce vasoconstriction or vasodilatation. Although this peptide is seen as a vasculotoxic substance, to date there is no prospective study examining the relationship between UTN and hard end points like cardiovascular (CV) events. UTN is much increased in end-stage renal disease (ESRD) and this disease may represent a useful natural model to explore the relationship between UTN and CV outcomes. In this study, we analysed the relationship between plasma UTN and incident CV events (fatal and non-fatal) in a cohort of 191 haemodialysis patients followed up for an average time of 3.6 years (range 0.07-5.8 years). Plasma UTN in haemodialysis patients (median: 6.5 ng/ml) was twice higher than in healthy subjects (median: 3.3 ng/ml). During the follow-up period, 94 patients died and 88 had incident fatal and non-fatal CV events. UTN was significantly lower in patients with incident CV events (median: 5.3 ng/ml) than in events-free patients (median: 7.1 ng/ml), and in a Kaplan-Meier analysis, high UTN was strongly and inversely associated with incident CV events (P<0.001). Multivariate Cox's regression analysis fully confirmed plasma UTN as an inverse predictor of adverse CV outcomes, and in this analysis, UTN resulted to be the third factor in rank, after age and diabetes, explaining the incidence of CV events. UTN is an inverse predictor of CV outcomes in ESRD. Our data suggest that UTN should not be necessarily seen as a vasculotoxic peptide in haemodialysis patients.
尾加压素 II（UTN）是一种血管活性物质，可引起血管收缩或舒张。尽管这种肽被视为一种血管毒性物质，但迄今为止，尚无前瞻性研究探讨 UTN 与心血管（CV）事件等硬终点之间的关系。UTN 在终末期肾病（ESRD）中显著升高，该疾病可能是探索 UTN 与 CV 结局之间关系的有用天然模型。在本研究中，我们分析了 191 例血液透析患者队列中血浆 UTN 与新发 CV 事件（致命和非致命）之间的关系，这些患者平均随访时间为 3.6 年（范围 0.07 - 5.8 年）。血液透析患者的血浆 UTN（中位数：6.5 ng/ml）是健康受试者（中位数：3.3 ng/ml）的两倍。在随访期间，94 例患者死亡，88 例发生了致命和非致命的 CV 事件。发生 CV 事件的患者的 UTN（中位数：5.3 ng/ml）显著低于无事件患者（中位数：7.1 ng/ml），在 Kaplan-Meier 分析中，高 UTN 与新发 CV 事件呈强烈负相关（P<0.001）。多变量 Cox 回归分析充分证实血浆 UTN 是不良 CV 结局的反向预测因子，在该分析中，UTN 是继年龄和糖尿病之后解释 CV 事件发生率的第三个因素。UTN 是 ESRD 中 CV 结局的反向预测因子。我们的数据表明，在血液透析患者中，UTN 不一定应被视为血管毒性肽。
