Departments of Cardiology and Nephrology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany.
Eur J Heart Fail. 2011 Oct;13(10):1104-10. doi: 10.1093/eurjhf/hfr102. Epub 2011 Aug 16.
Patients with chronic heart failure are often characterized by impaired renal function, also referred to as cardiorenal syndrome (CRS). The aim of this study was to assess whether novel markers of kidney injury are elevated in chronic heart failure and CRS.
The new renal biomarkers kidney injury molecule-1 (KIM-1), N-acetyl-ß-d-glucosaminidase (NAG) and neutrophil gelatinase-associated lipocalin (NGAL) were assessed from urine samples of 173 individuals. Patients with chronic heart failure (n= 150) were characterized by decreased ejection fraction (32 ± 9% vs. controls 62 ± 4%, P < 0.001) and increased plasma N-terminal pro-brain natriuretic peptide (median 1460 pg/mL, interquartile range (IQR) 630-3000 pg/mL vs. controls 56, IQR 25-64l pg/mL, P < 0.001). Urinary analysis showed that KIM-1 was significantly elevated in heart failure patients compared with healthy controls (1100, IQR 620-1920 vs. 550, IQR 320-740 ng/g urinary creatinine, P < 0.001). Further, KIM-1 increased significantly with decreasing left ventricular function (r = -0.37, P < 0.001) and severity of New York Heart Association (NYHA)-class (r = 0.5, P < 0.001). N-acetyl-ß-d-glucosaminidase showed a weaker response but correlated significantly with left ventricular dysfunction (r = -0.18, P= 0.015) and more severe clinical condition (r = 0.22, P= 0.04). In contrast, NGAL showed no significant correlation. Kidney injury molecule-1 and NAG were also predictors of all-cause mortality and the composite of all-cause mortality and rehospitalization for heart failure (all P < 0.05).
Kidney injury molecule-1 and NAG are elevated in symptomatic heart failure. This finding may be present in patients with apparently normal kidney function and indicates tubular injury in chronic heart failure. Kidney injury molecule-1 and NAG are potential markers of CRS with additional prognostic value.
慢性心力衰竭患者常伴有肾功能损害，也称为心肾综合征（CRS）。本研究旨在评估新型肾脏损伤标志物在慢性心力衰竭和 CRS 中的升高情况。
从 173 名个体的尿液样本中评估了新型肾脏生物标志物肾损伤分子-1（KIM-1）、N-乙酰-β-D-氨基葡萄糖苷酶（NAG）和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）。慢性心力衰竭患者（n=150）的特征为射血分数降低（32±9% vs. 对照组 62±4%，P<0.001）和血浆 N 末端脑利钠肽前体（中位数 1460pg/ml，四分位距（IQR）630-3000pg/ml vs. 对照组 56，IQR 25-64l pg/ml，P<0.001）升高。尿分析显示，心力衰竭患者的 KIM-1 明显高于健康对照组（1100，IQR 620-1920 vs. 550，IQR 320-740ng/g 尿肌酐，P<0.001）。此外，KIM-1 随着左心室功能的降低（r=-0.37，P<0.001）和纽约心脏协会（NYHA）分级的严重程度（r=0.5，P<0.001）而显著增加。N-乙酰-β-D-氨基葡萄糖苷酶反应较弱，但与左心室功能障碍显著相关（r=-0.18，P=0.015）和更严重的临床状况（r=0.22，P=0.04）。相反，NGAL 没有显著相关性。KIM-1 和 NAG 也是全因死亡率和全因死亡率和心力衰竭再住院的复合终点的预测因子（均 P<0.05）。
在有症状的心力衰竭患者中，肾损伤分子-1 和 NAG 升高。这种发现可能存在于肾功能正常的患者中，表明慢性心力衰竭存在肾小管损伤。KIM-1 和 NAG 是 CRS 的潜在标志物，具有额外的预后价值。
