Mirna Moritz, Topf Albert, Wernly Bernhard, Rezar Richard, Paar Vera, Jung Christian, Salmhofer Hermann, Kopp Kristen, Hoppe Uta C, Schulze P Christian, Kretzschmar Daniel, Schneider Markus P, Schultheiss Ulla T, Sommerer Claudia, Paul Katharina, Wolf Gunter, Lichtenauer Michael, Busch Martin
Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria.
Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany.
J Clin Med. 2020 Mar 24;9(3):886. doi: 10.3390/jcm9030886.
Chronic kidney disease (CKD) and cardiovascular diseases (CVD) often occur concomitantly, and CKD is a major risk factor for cardiovascular mortality. Since some of the most commonly used biomarkers in CVD are permanently elevated in patients with CKD, novel biomarkers are warranted for clinical practice. Plasma concentrations of five cardiovascular biomarkers (soluble suppression of tumorigenicity (sST2), growth differentiation factor 15 (GDF-15), heart-type fatty acid-binding protein (H-FABP), insulin-like growth factor-binding protein 2 (IGF-BP2), and soluble urokinase plasminogen activator receptor) were analyzed by means of enzyme-linked immunosorbent assay (ELISA) in 219 patients with CKD enrolled in the German Chronic Kidney Disease (GCKD) study. Except for sST2, all of the investigated biomarkers were significantly elevated in patients with CKD (2.0- to 4.4-fold increase in advanced CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m² body surface area (BSA)) and showed a significant inverse correlation with eGFR. Moreover, all but H-FABP and sST2 were additionally elevated in patients with micro- and macro-albuminuria. Based on our findings, sST2 appears to be the biomarker whose diagnostic performance is least affected by decreased renal function, thus suggesting potential viability in the management of patients with CVD and concomitant CKD. The predictive potential of sST2 remains to be proven in endpoint studies.
慢性肾脏病(CKD)与心血管疾病(CVD)常同时发生,且CKD是心血管疾病死亡的主要危险因素。由于CVD中一些最常用的生物标志物在CKD患者中持续升高,因此临床实践需要新的生物标志物。在参与德国慢性肾脏病(GCKD)研究的219例CKD患者中,采用酶联免疫吸附测定(ELISA)分析了五种心血管生物标志物(可溶性肿瘤抑制因子(sST2)、生长分化因子15(GDF-15)、心型脂肪酸结合蛋白(H-FABP)、胰岛素样生长因子结合蛋白2(IGF-BP2)和可溶性尿激酶型纤溶酶原激活物受体)的血浆浓度。除sST2外,所有研究的生物标志物在CKD患者中均显著升高(在晚期CKD(估计肾小球滤过率(eGFR)<30 mL/min/1.73 m²体表面积(BSA))中升高2.0至4.4倍),并与eGFR呈显著负相关。此外,除H-FABP和sST2外,微量和大量白蛋白尿患者的其他生物标志物也升高。基于我们的研究结果,sST2似乎是其诊断性能受肾功能下降影响最小的生物标志物,因此提示其在CVD合并CKD患者管理中的潜在可行性。sST2的预测潜力仍有待在终点研究中得到证实。