Wang Jun, Sim Ah Siew, Wang Xing Li, Salonikas Chris, Moriatis Mary, Naidoo Daya, Wilcken David E L
Department of Cardiovascular Medicine, University of New South Wales, Prince of Wales Hospital, Sydney, Australia.
Atherosclerosis. 2008 Apr;197(2):853-9. doi: 10.1016/j.atherosclerosis.2007.07.034. Epub 2007 Sep 10.
While renal failure greatly increases coronary risk, mild renal impairment is not usually considered a major risk factor. To explore this we assessed relations between measures of mild impairment of renal function and coronary artery disease (CAD) together with other risk factors.
In 408 consecutive patients aged 75 years or less with angiographically defined normal or obstructed coronary arteries and an estimated glomerular filtration rate (eGFR) >45 mL/min per 1.73 m(2), we assessed relations between severity of CAD and levels of plasma cystatin C, creatinine, eGFR, lipid profile, C-reactive protein (CRP), homocysteine, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA). With univariate ANOVA, the severity of CAD was significantly associated with all indices of renal function: increased plasma cystatin C (p=0.003) and creatinine (p=0.004) and decreased eGFR (p=0.008). An elevated plasma cystatin C was associated with increases in ADMA, SDMA, CRP, homocysteine and age. ADMA, SDMA, CRP and homocysteine levels were not associated with CAD severity. eGFR was negatively associated only with SDMA and homocysteine. In multivariate analysis, increased plasma cystatin C predicted both the occurrence and the severity of CAD more strongly than other measures of renal function.
We conclude that mild renal impairment detected by elevated cystatin C is associated with both the occurrence and the severity of CAD, independent of the other risk factors we measured and that mild renal impairment results in increased plasma levels of homocysteine, ADMA and SDMA. Our findings suggest a possible mechanistic link between CAD and mild renal impairment in which cystatin C may serve as an early marker for CAD and may also participate directly in atherogenesis.
虽然肾衰竭会大幅增加冠心病风险，但轻度肾功能损害通常不被视为主要危险因素。为探究这一情况，我们评估了轻度肾功能损害指标与冠状动脉疾病（CAD）以及其他危险因素之间的关系。
在408例年龄75岁及以下、经血管造影确定冠状动脉正常或阻塞且估计肾小球滤过率（eGFR）>45 mL/（min·1.73 m²）的连续患者中，我们评估了CAD严重程度与血浆胱抑素C、肌酐、eGFR、血脂谱、C反应蛋白（CRP）、同型半胱氨酸、不对称二甲基精氨酸（ADMA）和对称二甲基精氨酸（SDMA）水平之间的关系。采用单因素方差分析，CAD严重程度与所有肾功能指标均显著相关：血浆胱抑素C升高（p = 0.003）、肌酐升高（p = 0.004）以及eGFR降低（p = 0.008）。血浆胱抑素C升高与ADMA、SDMA、CRP、同型半胱氨酸和年龄增加有关。ADMA、SDMA、CRP和同型半胱氨酸水平与CAD严重程度无关。eGFR仅与SDMA和同型半胱氨酸呈负相关。在多因素分析中，血浆胱抑素C升高比其他肾功能指标更能强烈预测CAD的发生和严重程度。
我们得出结论，通过胱抑素C升高检测到的轻度肾功能损害与CAD的发生和严重程度均相关，独立于我们测量的其他危险因素，且轻度肾功能损害会导致血浆同型半胱氨酸、ADMA和SDMA水平升高。我们的研究结果提示CAD与轻度肾功能损害之间可能存在机制联系，其中胱抑素C可能作为CAD的早期标志物，也可能直接参与动脉粥样硬化的发生。
