Ha Lahati, Shi Jun-Bao, Yu Hai-Yi, Yang Kun, Wang Hai-Ning, Wang Fang-Fang, Han Jiang-Li
Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China.
Department of Nephrology, Peking University Third Hospital, Beijing, China.
J Geriatr Cardiol. 2020 Feb;17(2):67-73. doi: 10.11909/j.issn.1671-5411.2020.02.003.
Coronary artery calcification (CAC) is common in end-stage renal disease (ESRD) patients, and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients. Cartilage oligomeric matrix protein (COMP), as a component of the vascular matrix, has been found to be an inhibitor of arterial calcification in basic studies. However, there is no clinical research on the correlation between COMP and CAC in maintenance hemodialysis (MHD) patients. The aim of this study was to explore the relationship between serum COMP levels and CAC and cardiovascular events in MHD patients.
Serum COMP levels were compared between 54 MHD patients and 66 healthy people. MHD patients were then divided into three groups according to the tertiles of the concentration of COMP level and were followed up for major adverse cardiac events (MACEs), which were defined as a combined end point of new onset angina pectoris, nonfatal myocardial infarction, heart failure, coronary artery revascularization, hospitalization due to angina pectoris and all-cause deaths. The CAC score was calculated based on computed tomography scans.
The serum COMP level in MHD patients was significantly higher than that in the general population [984.23 (248.43-1902.61) ng/mL 219.01 (97.26-821.92) ng/mL, < 0.01]. Serum COMP levels were positively correlated with CAC ( = 0.313, = 0.021) and serum parathyroid hormone in MHD patients ( = 0.359, < 0.01). Linear regression suggested that after adjusting for age, fasting blood glucose (Glu) and glycosylated hemoglobin (HbAlc), CAC score was an independent predictor in the final model for COMP level ( = 0.424, = 3.130, < 0.01). The receiver operating characteristic (ROC) curve showed that COMP ≥ 994 mg/mL had 68.0% sensitivity and 72.4% specificity for the prediction of severe CAC [area under the curve (AUC): 0.674, = 0.030, 95% CI: 0.526-0.882]. After a median follow-up of 16 months (8-24 months), there was no difference in the incidence rate of MACEs between the upper, middle and lower serum COMP groups.
Our study found that MHD patients have higher levels of circulating COMP than controls. The serum COMP level is positively correlated with CAC score and could be used as a biomarker of severe CAC in MHD patients. However, there is no obvious correlation between serum COMP levels and the incidence of cardiovascular events.
冠状动脉钙化（CAC）在终末期肾病（ESRD）患者中很常见，且CAC的程度与ESRD患者的心血管结局密切相关。软骨寡聚基质蛋白（COMP）作为血管基质的一种成分，在基础研究中已被发现是动脉钙化的抑制剂。然而，关于维持性血液透析（MHD）患者中COMP与CAC之间的相关性尚无临床研究。本研究的目的是探讨MHD患者血清COMP水平与CAC及心血管事件之间的关系。
比较54例MHD患者和66例健康人的血清COMP水平。然后根据COMP水平浓度的三分位数将MHD患者分为三组，并对主要不良心脏事件（MACE）进行随访，MACE被定义为新发心绞痛、非致命性心肌梗死、心力衰竭、冠状动脉血运重建、因心绞痛住院和全因死亡的综合终点。基于计算机断层扫描计算CAC评分。
MHD患者的血清COMP水平显著高于普通人群[984.23（248.43 - 1902.61）ng/mL对219.01（97.26 - 821.92）ng/mL，P < 0.01]。MHD患者的血清COMP水平与CAC呈正相关（r = 0.313，P = 0.021），与血清甲状旁腺激素也呈正相关（r = 0.359，P < 0.01）。线性回归表明，在调整年龄、空腹血糖（Glu）和糖化血红蛋白（HbAlc）后，CAC评分是COMP水平最终模型中的独立预测因子（β = 0.424，t = 3.130，P < 0.01）。受试者工作特征（ROC）曲线显示，COMP≥994 mg/mL对严重CAC的预测敏感性为68.0%，特异性为72.4%[曲线下面积（AUC）：0.674，P = 0.030，95%CI：0.526 - 0.882]。中位随访16个月（8 - 月）后，血清COMP水平高、中、低三组之间MACE的发生率无差异。
我们的研究发现，MHD患者的循环COMP水平高于对照组。血清COMP水平与CAC评分呈正相关，可作为MHD患者严重CAC的生物标志物。然而，血清COMP水平与心血管事件的发生率之间无明显相关性。
