Haapio Mikko, House Andrew A, de Cal Massimo, Cruz Dinna N, Lentini Paolo, Giavarina Davide, Fortunato Antonio, Menghetti Luigi, Salgarello Matteo, Lupi Andrea, Soffiati Giuliano, Fontanelli Alessandro, Zanco Pierluigi, Ronco Claudio
Division of Nephrology, Meilahti Hospital, HUCH, P.O. Box 340, 00029 Helsinki, Finland.
Int J Nephrol. 2010 Oct 20;2011:425923. doi: 10.4061/2011/425923.
We examined association of inducible myocardial perfusion defects with cardiorenal biomarkers, and of diminished left ventricular ejection fraction (LVEF) with kidney injury marker plasma neutrophil gelatinase-associated lipocalin (NGAL). Patients undergoing nuclear myocardial perfusion stress imaging were divided into 2 groups. Biomarkers were analyzed pre- and poststress testing. Compared to the patients in the low ischemia group (n = 16), the patients in the high ischemia group (n = 18) demonstrated a significantly greater rise in cardiac biomarkers plasma BNP, NT-proBNP and cTnI. Subjects were also categorized based on pre- or poststress test detectable plasma NGAL. With stress, the group with no detectable NGAL had a segmental defect score 4.2 compared to 8.2 (P = .06) in the detectable NGAL group, and 0.9 vs. 3.8 (P = .03) at rest. BNP rose with stress to a greater degree in patients with detectable NGAL (10.2 vs. 3.5 pg/mL, P = .03). LVEF at rest and with stress was significantly lower in the detectable NGAL group; 55.8 versus 65.0 (P = .03) and 55.1 vs. 63.8 (P = .04), respectively. Myocardial perfusion defects associate with biomarkers of cardiac stress, and detectable plasma NGAL with significantly lower LVEF, suggesting a specific heart-kidney link.
我们研究了诱导性心肌灌注缺损与心肾生物标志物之间的关联，以及左心室射血分数（LVEF）降低与肾损伤标志物血浆中性粒细胞明胶酶相关脂质运载蛋白（NGAL）之间的关联。接受核素心肌灌注负荷显像的患者被分为两组。在负荷试验前后对生物标志物进行分析。与低缺血组患者（n = 16）相比，高缺血组患者（n = 18）的心脏生物标志物血浆脑钠肽（BNP）、N末端脑钠肽前体（NT-proBNP）和心肌肌钙蛋白I（cTnI）的升高幅度明显更大。还根据负荷试验前或后可检测到的血浆NGAL对受试者进行分类。负荷状态下，未检测到NGAL的组节段性缺损评分为4.2，而可检测到NGAL的组为8.2（P = 0.06），静息状态下分别为0.9和3.8（P = 0.03）。在可检测到NGAL的患者中，BNP随负荷升高的程度更大（10.2对3.5 pg/mL，P = 0.03）。可检测到NGAL的组静息和负荷状态下的LVEF均显著更低；分别为55.8对65.0（P = 0.03）和55.1对63.8（P = 0.04）。心肌灌注缺损与心脏应激生物标志物相关，可检测到的血浆NGAL与显著更低的LVEF相关，提示存在特定的心肾联系。
