肾功能和多种止血标志物：动脉粥样硬化多民族研究中的横断面关联。
Kidney function and multiple hemostatic markers: cross sectional associations in the multi-ethnic study of atherosclerosis.
机构信息
Department of Medicine, Division Nephrology, University of California San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143-0532, USA.
出版信息
BMC Nephrol. 2011 Jan 26;12:3. doi: 10.1186/1471-2369-12-3.
BACKGROUND
Defined as estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, chronic kidney disease (CKD) is strongly and independently associated with cardiovascular and overall mortality. We hypothesized that reduced kidney function would be characterized by abnormalities of hemostasis.
METHODS
We tested cross-sectional associations between (eGFR) and multiple hemostatic markers among 6751 participants representing a broad spectrum of kidney function in the Multi-Ethnic Study of Atherosclerosis (MESA). Kidney function was measured using cystatin C (eGFRcys) or creatinine, using CKD Epidemiology Collaboration (eGFRcr). Hemostatic markers included soluble thrombomodulin (sTM), soluble tissue factor (sTF), D-Dimer, von Willebrand factor (vWF), factor VIII, plasmin-antiplasmin complex (PAP), tissue factor pathway inhibitor (TFPI), plasminogen activator inhibitor-1 (PAI-1), and fibrinogen. Associations were tested using multivariable linear regression with adjustment for demographics and comorbidities.
RESULTS
In comparison to persons with eGFRcys >90 ml/min/1.73 m2, subjects with eGFRcys < 60 ml/min/1.73 m2 had adjusted levels of sTM, sTF, D-Dimer, PAP, Factor VIII, TFPI, vWF and fibrinogen that were respectively 86%, 68%, 44%, 22%, 17%, 15%, 12% and 6% higher. Subjects with eGFRcys 60-90 ml/min/1.73 m2 had adjusted levels that were respectively 16%, 14%, 12%, 6%, 6%, 6%, 11% and 4% higher (p < 0.05 for all). Percent differences were not significantly different when groups were categorized by eGFRcr.
CONCLUSIONS
Throughout a broad spectrum of kidney function, lower eGFR was associated with higher levels of hemostatic markers. Dysregulation of hemostasis may be a mechanism by which reduced kidney function promotes higher cardiovascular risk.
背景
定义为估计肾小球滤过率（eGFR）<60 ml/min/1.73 m2，慢性肾脏病（CKD）与心血管和总体死亡率呈强独立相关。我们假设肾功能降低的特征将是止血异常。
方法
我们在多民族动脉粥样硬化研究（MESA）中代表广泛肾功能范围的 6751 名参与者中测试了（eGFR）与多种止血标志物之间的横断面关联。使用胱抑素 C（eGFRcys）或肌酐测量肾功能，使用 CKD 流行病学合作组（eGFRcr）。止血标志物包括可溶性血栓调节蛋白（sTM）、可溶性组织因子（sTF）、D-二聚体、血管性血友病因子（vWF）、VIII 因子、纤溶酶-抗纤溶酶复合物（PAP）、组织因子途径抑制剂（TFPI）、纤溶酶原激活物抑制剂-1（PAI-1）和纤维蛋白原。使用多变量线性回归进行关联测试，并进行了调整以适应人口统计学和合并症。
结果
与 eGFRcys>90 ml/min/1.73 m2 的人相比，eGFRcys<60 ml/min/1.73 m2 的受试者的 sTM、sTF、D-二聚体、PAP、VIII 因子、TFPI、vWF 和纤维蛋白原水平分别高 86%、68%、44%、22%、17%、15%、12%和 6%。eGFRcys 60-90 ml/min/1.73 m2 的受试者的调整水平分别高 16%、14%、12%、6%、6%、6%、11%和 4%（所有 p<0.05）。当按 eGFRcr 对组进行分类时，百分比差异无显著差异。
结论
在广泛的肾功能范围内，较低的 eGFR 与较高的止血标志物水平相关。止血的失调可能是肾功能降低促进更高心血管风险的机制之一。
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