慢性肾脏病患者心血管疾病预测的心脏和肾脏标志物：社区动脉粥样硬化风险研究
Cardiac and kidney markers for cardiovascular prediction in individuals with chronic kidney disease: the Atherosclerosis Risk in Communities study.
作者信息
Matsushita Kunihiro, Sang Yingying, Ballew Shoshana H, Astor Brad C, Hoogeveen Ron C, Solomon Scott D, Ballantyne Christie M, Woodward Mark, Coresh Josef
机构信息
From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., Y.S., S.H.B., M.W., J.C.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.).
出版信息
Arterioscler Thromb Vasc Biol. 2014 Aug;34(8):1770-7. doi: 10.1161/ATVBAHA.114.303465. Epub 2014 May 29.
OBJECTIVE
Traditional predictors suboptimally predict cardiovascular disease (CVD) in individuals with chronic kidney disease (CKD). This study compared 5 nontraditional cardiac and kidney markers on the improvement of cardiovascular prediction among those with CKD.
APPROACH AND RESULTS
Among 8622 participants aged 52 to 75 years in the Atherosclerosis Risk in Communities (ARIC) Study, cardiac troponin T, N-terminal pro-B-type natriuretic peptide, cystatin C, β2-microglobulin, and β-trace protein were compared for improvement in predicting incident CVD after stratifying by CKD status (940 participants with CKD [kidney dysfunction or albuminuria]). During a median follow-up of 11.9 years, there were 1672 CVD events including coronary disease, stroke, and heart failure (336 cases in CKD). Every marker was independently associated with incident CVD in participants with and without CKD. The adjusted hazard ratios (per 1 SD) were larger for cardiac markers than for kidney markers, particularly in CKD (1.61 [95% confidence interval, 1.43-1.81] for cardiac troponin T, 1.50 [1.34-1.68] for N-terminal pro-B-type natriuretic peptide, and <1.26 for kidney markers). Particularly in CKD group, cardiac markers compared with kidney markers contributed to greater c-statistic increment (0.032-0.036 versus 0.012-0.015 from 0.679 with only conventional predictors in CKD and 0.008-0.011 versus 0.002-0.010 from 0.697 in non-CKD) and categorical net reclassification improvement (0.086-0.127 versus 0.020-0.066 in CKD and 0.057-0.077 versus 0.014-0.048 in non-CKD). The superiority of cardiac markers was largely consistent in individual CVD outcomes.
CONCLUSIONS
A greater improvement in cardiovascular prediction was observed for cardiac markers than for kidney markers in people with CKD. These results suggest that cardiac troponin T and N-terminal pro-B-type natriuretic peptide are useful for better CVD risk classification in this population.
目的
传统预测指标对慢性肾脏病（CKD）患者心血管疾病（CVD）的预测效果欠佳。本研究比较了5种非传统的心肾标志物对CKD患者心血管疾病预测能力的改善情况。
方法与结果
在社区动脉粥样硬化风险（ARIC）研究的8622名年龄在52至75岁的参与者中，对心肌肌钙蛋白T、N末端B型利钠肽原、胱抑素C、β2微球蛋白和β-微量蛋白进行了比较，以评估在根据CKD状态分层（940名CKD患者[肾功能不全或蛋白尿]）后对新发CVD的预测改善情况。在中位随访11.9年期间，共发生1672例CVD事件，包括冠心病、中风和心力衰竭（CKD患者中有336例）。每种标志物在有和没有CKD的参与者中均与新发CVD独立相关。心脏标志物的校正风险比（每1个标准差）高于肾脏标志物，在CKD患者中尤为明显（心肌肌钙蛋白T为1.61[95%置信区间，1.43 - 1.81]，N末端B型利钠肽原为1.50[1.34 - 1.68]，肾脏标志物<1.26）。特别是在CKD组中，与肾脏标志物相比，心脏标志物使c统计量增加更多（CKD组中从仅使用传统预测指标时的0.679增加0.032 - 0.036对0.012 - 0.015，非CKD组中从0.697增加0.008 - 0.011对0.002 - 0.010）以及分类净重新分类改善更多（CKD组中为0.086 - 0.127对0.020 - 0.066，非CKD组中为0.057 - 0.077对0.014 - 0.048）。心脏标志物的优越性在各个CVD结局中基本一致。
结论
在CKD患者中，心脏标志物对心血管疾病预测的改善程度大于肾脏标志物。这些结果表明，心肌肌钙蛋白T和N末端B型利钠肽原有助于对该人群进行更好的CVD风险分类。
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