Division of Nephrology, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Atherosclerosis. 2017 Aug;263:68-73. doi: 10.1016/j.atherosclerosis.2017.05.021. Epub 2017 May 19.
Tumor necrosis factor receptor type 1 (TNFR1) is associated with kidney disease and mortality risk in various populations. Whether or not kidney function mediates mortality risk is unknown. We evaluated associations of TNFR1 levels with measures of kidney function, cardiovascular events, and mortality in a population of veterans with stable ischemic heart disease.
TNFR1 was measured from baseline serum samples in the Heart and Soul Study; elevated levels were defined by the highest quartile (Q4, >3.4 ng/ml). We evaluated associations of high TNFR1 with baseline estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR) and with longitudinal changes in eGFR (rapid loss), as well as with incident myocardial infarction (MI), heart failure hospitalizations (HF), and mortality over a median follow-up time of 8.9 years. Covariates included demographics and comorbid conditions.
Among 985 participants who had TNFR1 measurements, median TNFR1 was 2.33 ng/ml (IQR 1.8-3.1). Relative to Q1, Q4 had higher risk of eGFR <60 ml/min/1.73 m (RR 11.71 [95% CI 5.46, 25.11]); ACR ≥ 30 mg/g (2.44 [1.15, 5.19]); and rapid loss in kidney function (2.10 [1.12, 3.92]). Although TNFR1 Q4 was associated with MI, HF, and mortality after demographic adjustment, there were no associations in fully-adjusted models (1.04 [0.44, 2.49]; 1.02 [0.48, 2.15]; 1.42 [0.88, 2.28], respectively).
Levels of TNFR1 are associated longitudinally with kidney function decline but not with MI, HF or mortality risk after adjustment. Kidney disease may mediate the risk of MI, HF, and mortality associated with TNFR1.
肿瘤坏死因子受体 1（TNFR1）与各种人群的肾脏疾病和死亡风险相关。肾功能是否会影响死亡风险尚不清楚。我们评估了 TNFR1 水平与稳定缺血性心脏病退伍军人人群中肾功能、心血管事件和死亡率的相关性。
在 Heart and Soul 研究中，从基线血清样本中测量了 TNFR1；升高的水平通过最高四分位数（Q4，>3.4ng/ml）来定义。我们评估了高 TNFR1 与基线估算肾小球滤过率（eGFR）和尿白蛋白与肌酐比（ACR）以及 eGFR 的纵向变化（快速下降）以及心肌梗死（MI）、心力衰竭住院（HF）的相关性，以及在中位随访时间为 8.9 年期间的死亡率。协变量包括人口统计学和合并症情况。
在 985 名接受 TNFR1 测量的参与者中，TNFR1 的中位数为 2.33ng/ml（IQR 1.8-3.1）。与 Q1 相比，Q4 具有 eGFR<60ml/min/1.73m 的更高风险（RR 11.71[95%CI 5.46,25.11]）；ACR≥30mg/g（2.44[1.15,5.19]）；以及肾功能快速下降（2.10[1.12,3.92]）。尽管 TNFR1 Q4 在人口统计学调整后与 MI、HF 和死亡率相关，但在完全调整的模型中没有相关性（1.04[0.44,2.49]；1.02[0.48,2.15]；1.42[0.88,2.28]）。
TNFR1 水平与肾功能下降呈纵向相关，但在调整后与 MI、HF 或死亡风险无关。肾脏疾病可能介导 TNFR1 与 MI、HF 和死亡率相关的风险。
