Anderson Josephine L C, Pagano Sabrina, Virzi Julien, Dullaart Robin P F, Annema Wijtske, Kuipers Folkert, Bakker Stephan J L, Vuilleumier Nicolas, Tietge Uwe J F
Department of Pediatrics, University Medical Center Groningen, University of Groningen, 1205 Groningen, The Netherlands.
Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospital, 1205 Geneva, Switzerland.
J Clin Med. 2019 Jun 29;8(7):948. doi: 10.3390/jcm8070948.
Renal transplant recipients (RTRs) are known to have a high cardio-vascular disease (CVD) burden only partly explained by traditional CVD risk factors. The aim of this paper was therefore to determine: i) the prognostic value of autoantibodies against apoA-1 (anti-apoA-1 IgG) for incidence of CVD mortality, all-cause mortality and graft failure in RTR. Four hundred and sixty two (462) prospectively included RTRs were followed for 7.0 years. Baseline anti-apoA-1 IgG were determined and associations with incidence of CVD mortality ( = 48), all-cause mortality ( = 92) and graft failure ( = 39) were tested. Kaplan-Meier analyses demonstrated significant associations between tertiles of anti-apoA-1 IgG and CVD mortality (log rank test: = 0.048). Adjusted Cox regression analysis showed a 54% increase in risk for CVD mortality for each anti-apoA-1 IgG levels standard deviation increase (hazard ratio [HR]: 1.54, 95% Confidence Interval [95%CI]: 1.14-2.05, = 0.005), and a 33% increase for all-cause mortality (HR: 1.33; 95%CI: 1.06-1.67, = 0.01), independent of CVD risk factors, renal function and HDL function. The association with all-cause mortality disappeared after excluding cases of CVD specific mortality. The sensitivity, specificity, positive predictive value, and negative predictive value of anti-apoA-1 positivity for CVD mortality were 18.0%, 89.3%, 17.0%, and 90.0%, respectively. HDL functionality was not associated with anti-apoA-1 IgG levels. This prospective study demonstrates that in RTR, anti-apoA-1 IgG are independent predictors of CVD mortality and are not associated with HDL functionality.
肾移植受者（RTRs）已知有较高的心血管疾病（CVD）负担，而传统的CVD危险因素仅能部分解释这一负担。因此，本文的目的是确定：i）抗载脂蛋白A-1自身抗体（抗apoA-1 IgG）对RTR中CVD死亡率、全因死亡率和移植失败发生率的预后价值。对462例前瞻性纳入的RTRs进行了7.0年的随访。测定了基线抗apoA-1 IgG，并测试了其与CVD死亡率（n = 48）、全因死亡率（n = 92）和移植失败（n = 39）发生率的关联。Kaplan-Meier分析表明，抗apoA-1 IgG三分位数与CVD死亡率之间存在显著关联（对数秩检验：p = 0.048）。校正后的Cox回归分析显示，抗apoA-1 IgG水平每增加一个标准差，CVD死亡风险增加54%（风险比[HR]：1.54，95%置信区间[95%CI]：1.14 - 2.05，p = 0.005），全因死亡率增加33%（HR：1.33；95%CI：1.06 - 1.67，p = 0.01），且独立于CVD危险因素、肾功能和高密度脂蛋白（HDL）功能。排除CVD特异性死亡病例后，与全因死亡率的关联消失。抗apoA-1阳性对CVD死亡率的敏感性、特异性、阳性预测值和阴性预测值分别为18.0%、89.3%、17.0%和90.0%。HDL功能与抗apoA-1 IgG水平无关。这项前瞻性研究表明，在RTR中，抗apoA-1 IgG是CVD死亡率的独立预测因子，且与HDL功能无关。
