Liu Kuan-Liang, Lee Kuang-Tso, Chang Chih-Hsiang, Chen Yung-Chang, Lin Shu-Min, Chu Pao-Hsien
Crit Care. 2014 May 16;18(3):R100. doi: 10.1186/cc13876.
Acute kidney injury (AKI) following acute myocardial infarction (AMI) is associated with unfavorable prognosis. Endothelial activation and injury were found to play a critical role in the development of both AKI and AMI. This pilot study aimed to determine whether the plasma markers of endothelial injury and activation could serve as independent predictors for AKI in patients with AMI.
This prospective study was conducted from March 2010 to July 2012 and enrolled consecutive 132 patients with AMI receiving percutaneous coronary intervention (PCI). Plasma levels of thrombomodulin (TM), von Willebrand factor (vWF), angiopoietin (Ang)-1, Ang-2, Tie-2, and vascular endothelial growth factor (VEGF) were measured on day 1 of AMI. AKI was defined as elevation of serum creatinine of more than 0.3 mg/dL within 48 hours.
In total, 13 out of 132 (9.8%) patients with AMI developed AKI within 48 hours. Compared with patients without AKI, patients with AKI had increased plasma levels of Ang-2 (6338.28 ± 5862.77 versus 2412.03 ± 1256.58 pg/mL, P = 0.033) and sTM (7.6 ± 2.26 versus 5.34 ± 2.0 ng/mL, P < 0.001), and lower estimated glomerular filtration rate (eGFR) (46.5 ± 20.2 versus 92.5 ± 25.5 mL/min/1.73 m2, P < 0.001). Furthermore, the areas under the receiver operating curves demonstrated that plasma thrombomodulin (TM) and Ang-2 levels on day 1 of AMI had modest discriminative powers for predicting AKI development following AMI (0.796, P <0.001; 0.833, P <0.001; respectively).
Endothelial activation, quantified by plasma levels of TM and Ang-2 may play an important role in development of AKI in patients with AMI.
急性心肌梗死（AMI）后发生的急性肾损伤（AKI）与不良预后相关。内皮细胞激活和损伤在AKI和AMI的发生发展中均起关键作用。本前瞻性研究旨在确定内皮损伤和激活的血浆标志物是否可作为AMI患者发生AKI的独立预测指标。
本前瞻性研究于2010年3月至2012年7月进行，纳入连续132例接受经皮冠状动脉介入治疗（PCI）的AMI患者。在AMI第1天测量血浆中血栓调节蛋白（TM）、血管性血友病因子（vWF）、血管生成素（Ang）-1、Ang-2、Tie-2和血管内皮生长因子（VEGF）的水平。AKI定义为48小时内血清肌酐升高超过0.3mg/dL。
132例AMI患者中，共有13例（9.8%）在48小时内发生AKI。与未发生AKI的患者相比，发生AKI的患者血浆Ang-2水平升高（6338.28±5862.77对2412.03±1256.58pg/mL，P=0.033），可溶性TM（sTM）水平升高（7.6±2.26对5.34±2.0ng/mL，P<0.001），估计肾小球滤过率（eGFR）降低（46.5±20.2对92.5±25.5mL/min/1.73m2，P<0.001）。此外，受试者工作特征曲线下面积显示，AMI第1天血浆血栓调节蛋白（TM）和Ang-2水平对预测AMI后AKI的发生具有中等鉴别能力（分别为0.796，P<0.001；0.833,P<0.001）。
通过血浆TM和Ang-2水平量化内皮细胞激活可能在AMI患者AKI的发生中起重要作用。
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