慢性肾脏病患者尿中性粒细胞明胶酶相关脂质运载蛋白与心血管疾病及死亡风险：慢性肾功能不全队列（CRIC）研究结果
Urine neutrophil gelatinase-associated lipocalin and risk of cardiovascular disease and death in CKD: results from the Chronic Renal Insufficiency Cohort (CRIC) Study.
作者信息
Liu Kathleen D, Yang Wei, Go Alan S, Anderson Amanda H, Feldman Harold I, Fischer Michael J, He Jiang, Kallem Radhakrishna R, Kusek John W, Master Stephen R, Miller Edgar R, Rosas Sylvia E, Steigerwalt Susan, Tao Kaixiang, Weir Matthew R, Hsu Chi-Yuan
机构信息
Department of Medicine, University of California, San Francisco, San Francisco, CA.
Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
出版信息
Am J Kidney Dis. 2015 Feb;65(2):267-74. doi: 10.1053/j.ajkd.2014.07.025. Epub 2014 Oct 11.
BACKGROUND
Chronic kidney disease is common and is associated with increased cardiovascular disease risk. Currently, markers of renal tubular injury are not used routinely to describe kidney health and little is known about the risk of cardiovascular events and death associated with these biomarkers independent of glomerular filtration-based markers (such as serum creatinine or albuminuria).
STUDY DESIGN
Cohort study, CRIC (Chronic Renal Insufficiency Cohort) Study.
SETTING & PARTICIPANTS: 3,386 participants with estimated glomerular filtration rate of 20 to 70mL/min/1.73m(2) enrolled from June 2003 through August 2008.
PREDICTOR
Urine neutrophil gelatinase-associated lipocalin (NGAL) concentration.
OUTCOMES
Adjudicated heart failure event, ischemic atherosclerotic event (myocardial infarction, ischemic stroke, or peripheral artery disease), and death through March 2011.
MEASUREMENTS
Urine NGAL measured at baseline with a 2-step assay using chemiluminescent microparticle immunoassay technology on an ARCHITECT i2000SR (Abbott Laboratories).
RESULTS
There were 428 heart failure events (during 16,383 person-years of follow-up), 361 ischemic atherosclerotic events (during 16,584 person-years of follow-up), and 522 deaths (during 18,214 person-years of follow-up). In Cox regression models adjusted for estimated glomerular filtration rate, albuminuria, demographics, traditional cardiovascular disease risk factors, and cardiac medications, higher urine NGAL levels remained associated independently with ischemic atherosclerotic events (adjusted HR for the highest [>49.5ng/mL] vs lowest [≤6.9ng/mL] quintile, 1.83 [95% CI, 1.20-2.81]; HR per 0.1-unit increase in log urine NGAL, 1.012 [95% CI, 1.001-1.023]), but not heart failure events or deaths.
LIMITATIONS
Urine NGAL was measured only once.
CONCLUSIONS
Among patients with chronic kidney disease, urine levels of NGAL, a marker of renal tubular injury, were associated independently with future ischemic atherosclerotic events, but not with heart failure events or deaths.
背景
慢性肾脏病很常见，且与心血管疾病风险增加相关。目前，肾小管损伤标志物未被常规用于描述肾脏健康状况，对于这些生物标志物独立于基于肾小球滤过的标志物（如血清肌酐或蛋白尿）所关联的心血管事件和死亡风险知之甚少。
研究设计
队列研究，慢性肾功能不全队列（CRIC）研究。
研究地点与参与者
2003年6月至2008年8月招募的3386名估计肾小球滤过率为20至70mL/（min/1.73m²）的参与者。
预测指标
尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）浓度。
研究结果
判定的心力衰竭事件、缺血性动脉粥样硬化事件（心肌梗死、缺血性中风或外周动脉疾病）以及截至2011年3月的死亡情况。
测量方法
在基线时使用ARCHITECT i2000SR（雅培实验室）上的化学发光微粒免疫分析技术通过两步法测定尿NGAL。
结果
发生428例心力衰竭事件（随访16383人年）、361例缺血性动脉粥样硬化事件（随访16584人年）以及522例死亡（随访18214人年）。在针对估计肾小球滤过率、蛋白尿、人口统计学特征、传统心血管疾病风险因素和心脏用药进行校正的Cox回归模型中，较高的尿NGAL水平仍独立与缺血性动脉粥样硬化事件相关（最高[>49.5ng/mL]与最低[≤6.9ng/mL]五分位数的校正风险比，1.83[95%CI，1.20 - 2.81]；尿NGAL对数每增加0.1个单位的风险比，1.012[95%CI，1.001 - 1.023]），但与心力衰竭事件或死亡无关。
局限性
仅测量了一次尿NGAL。
结论
在慢性肾脏病患者中，肾小管损伤标志物尿NGAL水平独立与未来缺血性动脉粥样硬化事件相关，但与心力衰竭事件或死亡无关。
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