Elsaeed Amany M, Ibrahiem Amal H, Ali Asmaa A
Department of Clinical Pathology, Faculty of Medicine for girls, Al-Azhar University, Cairo, Egypt.
Department of Internal Medicine, Faculty of Medicine for girls, Al-Azhar University, Cairo, Egypt.
Egypt J Immunol. 2017 Jan;24(1):153-164.
The prevalence of chronic kidney disease (CKD) is rising continuously. Cardiovascular disease (CVD) is among the leading causes of death and premature mortality of patients with CKD. It has been suggested that the assessment of CKD-associated CVD risk factors together with conventional risk factors should be performed in order to improve the prediction of coronary heart disease risk. The reduction of these factors seems to be effective in lowering cardiovascular (CV) morbidity and mortality in patients with CKD. Measuring subclinical atherosclerosis in CKD may significantly improve CVD risk prediction. Additionally, novel early atherosclerosis biomarkers, as well as possible therapeutic targets, are greatly needed in CKD patients. Matrix Metalloproteinase 2 (MMP2) and osteoprotegerin (OPG) may fall into this category of both useful markers and targets in CKD disease. The aim of this study was to investigate MMP2 and OPG as markers of increased risk of atherosclerosis in CKD. The present study included 40 patients with CKD divided into two groups: 20 patients with stage 1-4 (group I) and 20 patients with end stage renal disease (ESRD) (group II). They were compared with 20 sex and age matched healthy individuals as a control group (group III). Levels of MMP2, OPG were measured by ELISA. Cardiac echocardiography was performed to assess structural integrity and function. There was highly significant increase in MMP2 and OPG levels in group II when compared with group I and group III (P=0.000 and P=0.000 respectively) and in group I when compared with group III (P=0.000). A highly significant difference was also found between the three groups as regard mitral and aortic calcification (P=0.000) and mitral, aortic and tricuspid regurge (P=0.000, 0.002 and 0.001 respectively). There was a positive correlation between OPG and MMP2 and significant relation between OPG and mitral and aortic calcification. In conclusion, MMP-2 and OPG may be involved in the pathogenesis of atherosclerosis in patients with CKD and could potentially be of use as biomarkers of subclinical atherosclerosis in these patients. The increase in mitral and aortic calcifications may suggest the reasons for increased CV risk in these patients.
慢性肾脏病（CKD）的患病率在持续上升。心血管疾病（CVD）是CKD患者死亡和过早死亡的主要原因之一。有人提出，应同时评估与CKD相关的心血管疾病危险因素和传统危险因素，以改善冠心病风险的预测。降低这些因素似乎能有效降低CKD患者的心血管（CV）发病率和死亡率。检测CKD患者的亚临床动脉粥样硬化可能会显著改善心血管疾病风险预测。此外，CKD患者迫切需要新型早期动脉粥样硬化生物标志物以及可能的治疗靶点。基质金属蛋白酶2（MMP2）和骨保护素（OPG）可能属于CKD疾病中有用的标志物和靶点这一类别。本研究的目的是调查MMP2和OPG作为CKD患者动脉粥样硬化风险增加的标志物。本研究纳入了40例CKD患者，分为两组：20例1 - 4期患者（第一组）和20例终末期肾病（ESRD）患者（第二组）。将他们与20名年龄和性别匹配的健康个体作为对照组（第三组）进行比较。采用酶联免疫吸附测定法（ELISA）检测MMP2、OPG水平。进行心脏超声心动图检查以评估结构完整性和功能。与第一组和第三组相比，第二组的MMP2和OPG水平显著升高（分别为P = 0.000和P = 0.000），与第三组相比，第一组也显著升高（P = 0.000）。在二尖瓣和主动脉钙化方面（P = 0.000）以及二尖瓣、主动脉和三尖瓣反流方面（分别为P = 0.000、0.002和0.001），三组之间也存在高度显著差异。OPG与MMP2之间存在正相关，OPG与二尖瓣和主动脉钙化之间存在显著关系。总之，MMP - 2和OPG可能参与了CKD患者动脉粥样硬化的发病机制，并且有可能作为这些患者亚临床动脉粥样硬化的生物标志物。二尖瓣和主动脉钙化的增加可能提示了这些患者心血管风险增加的原因。
