Department of Nephrology, Lund University, Lund, Sweden.
BMC Cardiovasc Disord. 2013 Sep 13;13:72. doi: 10.1186/1471-2261-13-72.
Micro-albuminuria is a recognized predictor of cardiovascular morbidity and mortality in patients with coronary artery disease. We have previously reported, in diabetic and non-diabetic patients, that an increased urinary excretion of IgM is associated with higher cardiovascular mortality. The purpose of this study was to investigate the pattern of urinary IgM excretion in patients with acute coronary syndrome (ACS) and its correlation to cardiovascular outcome.
Urine albumin, and IgM to creatinine concentration ratios were determined in 178 consecutive patients presenting with chest pain to the Department of Emergency Medicine (ED) at the University Hospital of Lund. Fifty eight (23 female) patients had ACS, 55 (19 female) patients had stable angina (SA), and 65 (35 female) patients were diagnosed as non-specific chest pain (NS).
Urine albumin and IgM excretions were significantly higher in patients with ACS (p = 0.001, and p = 0.029, respectively) compared to patients with NS-chest pain. During the 2 years follow-up time, 40 (19 female) patients suffered a new major cardiovascular event (ACS, acute heart failure, stroke) and 5 (4 male/1 female) patients died of cardiovascular cause. A high degree of albuminuria and IgM-uria significantly predicted cardiovascular mortality and morbidity (HR = 2.89, 95% CI: 1.48 - 5.66, p = 0.002). Microalbuminuric patients (≥3 mg/mmol) with high IgM-uria (≥0.005 mg/mmol) had a 3-fold higher risk for cardiovascular new events compared to patients with low IgM-uria (RR = 3.3, 95% CI: 1.1 - 9.9, p = 0.001).
In patients with chest pain, an increased urine IgM excretion, is associated with coronary artery disease and long-term cardiovascular complications. Measuring urine IgM concentration could have a clinical value in risk stratification of patients with ACS.
微量白蛋白尿是冠心病患者心血管发病率和死亡率的公认预测指标。我们之前曾报道，在糖尿病和非糖尿病患者中，IgM 尿排泄增加与心血管死亡率升高有关。本研究的目的是研究急性冠状动脉综合征（ACS）患者尿 IgM 排泄模式及其与心血管结局的关系。
在隆德大学医院急诊科就诊的 178 例胸痛连续患者中，测定尿白蛋白和 IgM 与肌酐浓度比。58 例（23 例女性）患者为 ACS，55 例（19 例女性）患者为稳定型心绞痛（SA），65 例（35 例女性）患者为非特异性胸痛（NS）。
与 NS 胸痛患者相比，ACS 患者的尿白蛋白和 IgM 排泄明显升高（p=0.001 和 p=0.029）。在 2 年随访期间，40 例（19 例女性）患者发生新的主要心血管事件（ACS、急性心力衰竭、中风），5 例（4 例男性/1 例女性）患者死于心血管原因。高度蛋白尿和 IgM-尿显著预测心血管死亡率和发病率（HR=2.89，95%CI：1.48-5.66，p=0.002）。微量白蛋白尿（≥3mg/mmol）合并高 IgM-尿（≥0.005mg/mmol）的患者发生心血管新事件的风险是低 IgM-尿患者的 3 倍（RR=3.3，95%CI：1.1-9.9，p=0.001）。
在胸痛患者中，尿 IgM 排泄增加与冠状动脉疾病和长期心血管并发症有关。测量尿 IgM 浓度可能对 ACS 患者的风险分层具有临床价值。
