成纤维细胞生长因子 2 浓度与慢性肾脏病患者动脉粥样硬化进展的关系。
Association of FGF-2 Concentrations with Atheroma Progression in Chronic Kidney Disease Patients.
机构信息
Vascular and Renal Translational Research Group, Institut de Recerca Biomedica de Lleida, Lleida, Spain; and.
Instituto de Investigacion Sanitaria Fundación Jiménez Díaz, Autonomous University of Madrid, Red de Investigación Renal del Instituto de Salud Carlos III, Madrid, Spain.
出版信息
Clin J Am Soc Nephrol. 2018 Apr 6;13(4):577-584. doi: 10.2215/CJN.07980717. Epub 2018 Mar 8.
BACKGROUND AND OBJECTIVES
Atherosclerosis is highly prevalent in CKD. The rate of progression of atherosclerosis is associated with cardiovascular events. Fibroblast growth factor 2 (FGF-2) is a member of the FGF family with potentially both protective and deleterious effects in the development of atherosclerosis. The role of circulating FGF-2 levels in the progression of atherosclerosis in CKD is unknown.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We used a multicenter, prospective, observational cohorts study of 481 patients with CKD. We determined the presence of atheroma plaque in ten arterial territories by carotid and femoral ultrasounds. Progression of atheromatosis was defined as an increase in the number of territories with plaque after 24 months. Plasma levels of FGF-2 were measured by multiplex analysis. A multivariable logistic regression analysis was performed to determine whether plasma FGF-2 levels were associated with atheromatosis progression.
RESULTS
Average age of the population was 61 years. The percentage of patients in each CKD stage was 51% in stage 3, 41% in stages 4-5, and 8% in dialysis. A total of 335 patients (70%) showed plaque at baseline. Atheromatosis progressed in 289 patients (67%). FGF-2 levels were similar between patients with or without plaque at baseline (79 versus 88 pg/ml), but lower in patients with atheromatosis progression after 2 years (78 versus 98 pg/ml; <0.01). In adjusted analyses, higher plasma FGF-2 was associated with lower risk of atheromatosis progression (odds ratio [OR], 0.86; 95% confidence interval [95% CI], 0.76 to 0.96; per 50 pg/ml increment). Analysis of FGF-2 in tertiles showed that atheroma progression was observed for 102 participants in the lowest tertile of FGF-2 (reference group), 86 participants in the middle tertile of FGF-2 (adjusted OR, 0.70; 95% CI, 0.40 to 1.20), and 74 participants in the lowest tertile of FGF-2 (adjusted OR, 0.48; 95% CI, 0.28 to 0.82).
CONCLUSIONS
Low FGF-2 levels are independently associated with atheromatosis progression in CKD.
背景与目的
动脉粥样硬化在慢性肾脏病（CKD）中非常普遍。动脉粥样硬化的进展速度与心血管事件相关。成纤维细胞生长因子 2（FGF-2）是成纤维细胞生长因子家族的一员，在动脉粥样硬化的发生发展中可能具有保护作用和有害作用。在 CKD 中，循环 FGF-2 水平与动脉粥样硬化进展的关系尚不清楚。
设计、地点、参与者和测量：我们采用了一项多中心、前瞻性、观察性队列研究，纳入了 481 名 CKD 患者。通过颈动脉和股动脉超声检查确定了 10 个动脉区域的动脉粥样斑块。粥样硬化进展定义为 24 个月后斑块数量增加的区域数量。通过多重分析测定 FGF-2 的血浆水平。采用多变量逻辑回归分析确定血浆 FGF-2 水平是否与动脉粥样硬化进展有关。
结果
人群平均年龄为 61 岁。每个 CKD 阶段的患者比例分别为：3 期 51%、4-5 期 41%和透析期 8%。基线时共有 335 名患者（70%）有斑块。289 名患者（67%）的动脉粥样硬化进展。基线时有斑块的患者和无斑块的患者的 FGF-2 水平相似（79 与 88 pg/ml），但 2 年后有动脉粥样硬化进展的患者 FGF-2 水平较低（78 与 98 pg/ml；<0.01）。在调整分析中，较高的血浆 FGF-2 水平与动脉粥样硬化进展的风险降低相关（比值比[OR]，0.86；95%置信区间[95%CI]，0.76 至 0.96；每增加 50 pg/ml）。FGF-2 三分位分析显示，在 FGF-2 最低三分位的 102 名患者（参考组）、FGF-2 中间三分位的 86 名患者（调整 OR，0.70；95%CI，0.40 至 1.20）和 FGF-2 最低三分位的 74 名患者（调整 OR，0.48；95%CI，0.28 至 0.82）中观察到动脉粥样硬化进展。
结论
在 CKD 中，低 FGF-2 水平与动脉粥样硬化进展独立相关。
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