Yilmaz Mahmut I, Demirkaya Erkan, Acikel Cengizhan, Saldir Mehmet, Akar Servet, Cayci Tuncer, Saglam Mutlu, Unal Hilmi U, Gok Mahmut, Polat Adem, Cetinkaya Hakkı, Eyileten Tayfun, Sari Sebahattin, Yildirim Ali O, Sonmez Alper, Oguz Yusuf, Vural Abdulgaffar, Ozen Seza, Carrero Juan Jesús
Department of Nephrology, Department of Pediatric Rheumatology, Gülhane School of Medicine, FMF Arthritis Vasculitis and Orphan Disease Research Center, Institute of Health Sciences, R&D Center, Ankara, Department of Rheumatology, Eylül University, Izmir, Department of Biochemistry, Department of Radiology, Department of Endocrinology, Gülhane School of Medicine, Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey, Center for Molecular Medicine and Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Nephrology, Department of Pediatric Rheumatology, Gülhane School of Medicine, FMF Arthritis Vasculitis and Orphan Disease Research Center, Institute of Health Sciences, R&D Center, Ankara, Department of Rheumatology, Eylül University, Izmir, Department of Biochemistry, Department of Radiology, Department of Endocrinology, Gülhane School of Medicine, Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey, Center for Molecular Medicine and Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden. Department of Nephrology, Department of Pediatric Rheumatology, Gülhane School of Medicine, FMF Arthritis Vasculitis and Orphan Disease Research Center, Institute of Health Sciences, R&D Center, Ankara, Department of Rheumatology, Eylül University, Izmir, Department of Biochemistry, Department of Radiology, Department of Endocrinology, Gülhane School of Medicine, Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey, Center for Molecular Medicine and Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden.
Rheumatology (Oxford). 2014 Nov;53(11):2002-8. doi: 10.1093/rheumatology/keu231. Epub 2014 Jun 6.
Secondary amyloidosis is the most important complication of FMF and endothelial function is more severely impaired. Elevated asymmetric dimethyl arginine (ADMA) may mediate the excess cardiovascular disease (CVD) risk of this group. We aimed to compare endothelial function characteristics, including ADMA, in patients with FMF-related amyloidosis and primary glomerulopathies and to define risk factors for a CVD event.
We undertook a cross-sectional study with prospective follow-up including consecutive patients with FMF-related amyloidosis (n = 98) or other non-diabetic glomerulopathies (n = 102). All patients had nephrotic-range proteinuria and normal glomerular filtration rate. Flow-mediated dilatation (FMD) was assessed and ADMA levels, CRP and pentraxin 3 (PTX3) were determined. Patients were followed for cardiovascular events.
Amyloidosis patients secondary to FMF showed higher levels of ADMA, CRP and PTX3 and lower FMD as compared with patients with other glomerulopathies. Cardiovascular events (n = 54) were registered during 3 years of follow-up. Increased ADMA levels and lower FMD were observed in patients with cardiovascular risk in both groups, but especially in individuals with amyloidosis.
Patients with FMF-related amyloidosis have increased CVD event risk, probably related to the high ADMA levels, elevated inflammatory markers and decreased FMD measures observed in these patients.
继发性淀粉样变性是家族性地中海热（FMF）最重要的并发症，且内皮功能受损更为严重。不对称二甲基精氨酸（ADMA）升高可能介导了该组人群心血管疾病（CVD）风险增加。我们旨在比较FMF相关性淀粉样变性患者和原发性肾小球疾病患者的内皮功能特征，包括ADMA，并确定CVD事件的危险因素。
我们进行了一项横断面研究并进行前瞻性随访，纳入连续的FMF相关性淀粉样变性患者（n = 98）或其他非糖尿病性肾小球疾病患者（n = 102）。所有患者均有肾病范围蛋白尿且肾小球滤过率正常。评估血流介导的血管舒张（FMD），并测定ADMA水平、C反应蛋白（CRP）和五聚素3（PTX3）。对患者进行心血管事件随访。
与其他肾小球疾病患者相比，FMF继发的淀粉样变性患者ADMA、CRP和PTX3水平更高，FMD更低。在3年随访期间记录到54例心血管事件。两组有心血管风险的患者中均观察到ADMA水平升高和FMD降低，尤其是淀粉样变性患者。
FMF相关性淀粉样变性患者发生CVD事件的风险增加，可能与这些患者中观察到的高ADMA水平、炎症标志物升高和FMD降低有关。
