尿维生素D结合蛋白和肾损伤分子-1是接受冠状动脉造影患者主要不良肾脏事件的有力新生物标志物。
Urinary Vitamin D Binding Protein and KIM-1 Are Potent New Biomarkers of Major Adverse Renal Events in Patients Undergoing Coronary Angiography.
作者信息
Chaykovska Lyubov, Heunisch Fabian, von Einem Gina, Alter Markus L, Hocher Carl-Friedrich, Tsuprykov Oleg, Dschietzig Thomas, Kretschmer Axel, Hocher Berthold
机构信息
Center for Cardiovascular Research, Charité Universitaetsmedizin Berlin, Berlin, Germany.
Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
出版信息
PLoS One. 2016 Jan 11;11(1):e0145723. doi: 10.1371/journal.pone.0145723. eCollection 2016.
BACKGROUND
Vitamin-D-binding protein (VDBP) is a low molecular weight protein that is filtered through the glomerulus as a 25-(OH) vitamin D 3/VDBP complex. In the normal kidney VDBP is reabsorbed and catabolized by proximal tubule epithelial cells reducing the urinary excretion to trace amounts. Acute tubular injury is expected to result in urinary VDBP loss. The purpose of our study was to explore the potential role of urinary VDBP as a biomarker of an acute renal damage.
METHOD
We included 314 patients with diabetes mellitus or mild renal impairment undergoing coronary angiography and collected blood and urine before and 24 hours after the CM application. Patients were followed for 90 days for the composite endpoint major adverse renal events (MARE: need for dialysis, doubling of serum creatinine after 90 days, unplanned emergency rehospitalization or death).
RESULTS
Increased urine VDBP concentration 24 hours after contrast media exposure was predictive for dialysis need (no dialysis: 113.06 ± 299.61 ng/ml, n = 303; need for dialysis: 613.07 ± 700.45 ng/ml, n = 11, Mean ± SD, p<0.001), death (no death during follow-up: 121.41 ± 324.45 ng/ml, n = 306; death during follow-up: 522.01 ± 521.86 ng/ml, n = 8; Mean ± SD, p<0.003) and MARE (no MARE: 112.08 ± 302.00 ng/ml, n = 298; MARE: 506.16 ± 624.61 ng/ml, n = 16, Mean ± SD, p<0.001) during the follow-up of 90 days after contrast media exposure. Correction of urine VDBP concentrations for creatinine excretion confirmed its predictive value and was consistent with increased levels of urinary Kidney Injury Molecule-1 (KIM-1) and baseline plasma creatinine in patients with above mentioned complications. The impact of urinary VDBP and KIM-1 on MARE was independent of known CIN risk factors such as anemia, preexisting renal failure, preexisting heart failure, and diabetes.
CONCLUSIONS
Urinary VDBP is a promising novel biomarker of major contrast induced nephropathy-associated events 90 days after contrast media exposure.
背景
维生素D结合蛋白（VDBP）是一种低分子量蛋白质，它作为25-（OH）维生素D3/VDBP复合物通过肾小球滤过。在正常肾脏中，VDBP被近端肾小管上皮细胞重吸收并分解代谢，从而使尿排泄量减少至微量。急性肾小管损伤预计会导致尿VDBP丢失。我们研究的目的是探讨尿VDBP作为急性肾损伤生物标志物的潜在作用。
方法
我们纳入了314例患有糖尿病或轻度肾功能损害且正在接受冠状动脉造影的患者，并在使用造影剂前及使用后24小时采集血液和尿液。对患者进行90天的随访，观察复合终点主要不良肾脏事件（MARE：透析需求、90天后血清肌酐翻倍、计划外紧急再次住院或死亡）。
结果
造影剂暴露后24小时尿VDBP浓度升高可预测透析需求（无需透析：113.06±299.61 ng/ml，n = 303；需要透析：613.07±700.45 ng/ml，n = 11，均值±标准差，p<0.001）、死亡（随访期间未死亡：121.41±324.45 ng/ml，n = 306；随访期间死亡：522.01±521.86 ng/ml，n = 8；均值±标准差，p<0.003）以及造影剂暴露后90天随访期间的MARE（无MARE：112.08±302.00 ng/ml，n = 298；MARE：506.16±624.61 ng/ml，n = 16，均值±标准差，p<0.
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