在慢性肾功能不全队列（CRIC）研究中，血清β-微量蛋白和β2-微球蛋白作为慢性肾脏病成年患者终末期肾病、死亡率和心血管疾病的预测指标。
Serum β-Trace Protein and β2-Microglobulin as Predictors of ESRD, Mortality, and Cardiovascular Disease in Adults With CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study.
作者信息
Foster Meredith C, Coresh Josef, Hsu Chi-Yuan, Xie Dawei, Levey Andrew S, Nelson Robert G, Eckfeldt John H, Vasan Ramachandran S, Kimmel Paul L, Schelling Jeffrey, Simonson Michael, Sondheimer James H, Anderson Amanda Hyre, Akkina Sanjeev, Feldman Harold I, Kusek John W, Ojo Akinlolu O, Inker Lesley A
机构信息
Tufts Medical Center, Boston, MA.
Johns Hopkins University, Baltimore, MD.
出版信息
Am J Kidney Dis. 2016 Jul;68(1):68-76. doi: 10.1053/j.ajkd.2016.01.015. Epub 2016 Mar 3.
BACKGROUND
Serum β-trace protein (BTP) and β2-microglobulin (B2M) are independently associated with end-stage renal disease (ESRD) and mortality in the general population and high-risk groups with diabetes or advanced chronic kidney disease (CKD). Less is known about their associations with outcomes and predictive ability in adults with moderate CKD.
STUDY DESIGN
Prospective cohort study.
SETTING & PARTICIPANTS: 3,613 adults from the CRIC (Chronic Renal Insufficiency Cohort) Study (45% women; mean age, 57.9 years; 41.0% non-Hispanic black; 51.9% with diabetes).
PREDICTORS
BTP and B2M levels with a reciprocal transformation to reflect their associations with filtration, creatinine-based estimated glomerular filtration rate (eGFRcr), measured GFR, and a 4-marker composite score combining BTP, B2M, creatinine, and cystatin C levels. Predictors were standardized as z scores for comparisons across filtration markers.
OUTCOMES
ESRD, all-cause mortality, and new-onset cardiovascular disease.
RESULTS
During a 6-year median follow-up, 755 (21%) participants developed ESRD, 653 died, and 292 developed new-onset cardiovascular disease. BTP, B2M, and the 4-marker composite score were independent predictors of ESRD and all-cause mortality, and B2M and the 4-marker composite score of cardiovascular events, after multivariable adjustment. These associations were stronger than those observed for eGFRcr (P vs eGFRcr≤0.02). The 4-marker composite score led to improvements in C statistic and 2.5-year risk reclassification beyond eGFRcr for all outcomes.
LIMITATIONS
Filtration markers measured at one time point; measured GFR available in subset of cohort.
CONCLUSIONS
BTP and B2M levels may contribute additional risk information beyond eGFRcr, and the use of multiple markers may improve risk prediction beyond this well-established marker of kidney function among persons with moderate CKD.
背景
血清β-微量蛋白（BTP）和β2-微球蛋白（B2M）与终末期肾病（ESRD）以及普通人群和患有糖尿病或晚期慢性肾脏病（CKD）的高危人群的死亡率独立相关。关于它们在中度CKD成人中的预后关联和预测能力，人们了解较少。
研究设计
前瞻性队列研究。
研究地点与参与者
来自慢性肾功能不全队列（CRIC）研究的3613名成年人（45%为女性；平均年龄57.9岁；41.0%为非西班牙裔黑人；51.9%患有糖尿病）。
预测指标
对BTP和B2M水平进行倒数转换，以反映它们与滤过、基于肌酐的估计肾小球滤过率（eGFRcr）、测量的肾小球滤过率（GFR）以及结合BTP、B2M、肌酐和胱抑素C水平的4指标综合评分之间的关联。预测指标标准化为z分数，以便在各滤过指标间进行比较。
结局指标
ESRD、全因死亡率和新发心血管疾病。
结果
在中位6年的随访期间，755名（21%）参与者发生了ESRD，653人死亡，292人发生了新发心血管疾病。经过多变量调整后，BTP、B2M和4指标综合评分是ESRD和全因死亡率的独立预测指标，B2M和4指标综合评分是心血管事件的独立预测指标。这些关联比eGFRcr观察到的关联更强（P与eGFRcr相比≤0.02）。4指标综合评分在所有结局方面均使C统计量和2.5年风险重新分类相对于eGFRcr有所改善。
局限性
在一个时间点测量滤过指标；队列的一个子集中有测量的GFR数据。
结论
BTP和B2M水平可能提供超出eGFRcr的额外风险信息，并且在中度CKD患者中，使用多个指标可能比这个已确立的肾功能指标更能改善风险预测。
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