Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
Atherosclerosis. 2020 Jun;303:46-52. doi: 10.1016/j.atherosclerosis.2020.03.016. Epub 2020 Mar 21.
Calciprotein particles (CPPs), nano-aggregates containing fetuin-A-bound calcium-phosphate, are associated with aortic stiffness and coronary calcification in maintenance hemodialysis patients. A novel gel-filtration assay can detect low-density small CPPs, which are actually a major form of circulating CPPs in vivo. We sought to investigate whether circulating CPP levels measured by gel-filtration method would accurately predict hard endpoints in maintenance hemodialysis patients.
This study used a prospective, multicenter, longitudinal, and observational design. One-hundred eight patients enrolled in this study were followed-up for about 2 years. We reported all-cause death and cardiovascular events, which included major adverse cardiac, cerebrovascular, and limb events.
Kaplan-Meier analysis showed no significant difference between patients with the higher (>median) and lower (<median) CPP levels with regard to all-cause death. However, the higher CPP group showed a higher incidence of cardiovascular events (log-rank test χ = 4.41, p = 0.036). Univariate Cox regression analysis revealed that CPP levels were not associated with all-cause death, but were significantly associated with higher incidence of cardiovascular events (hazard ratio (HR) 1.03, 95% confidence interval (CI) [1.02-1.05], p < 0.001) for every thousand CPP increase. Multivariate Cox regression analysis revealed that CPP levels were not associated with all-cause death, but were independently associated with cardiovascular events (HR 1.03, 95% CI [1.01-1.04], p < 0.001) for every thousand CPP.
This finding suggests a potential predictive value of CPPs in maintenance hemodialysis patients.
含有结合了胎球蛋白 A 的钙磷的钙磷蛋白颗粒（CPPs）与维持性血液透析患者的主动脉僵硬和冠状动脉钙化有关。一种新的凝胶过滤分析可以检测到低浓度的小 CPPs，这些 CPPs 实际上是体内循环 CPPs 的主要形式。我们试图研究通过凝胶过滤法测量的循环 CPP 水平是否能准确预测维持性血液透析患者的硬终点。
本研究采用前瞻性、多中心、纵向和观察性设计。108 名患者参与了这项研究，随访时间约为 2 年。我们报告了全因死亡和心血管事件，包括主要的不良心脏、脑血管和肢体事件。
Kaplan-Meier 分析显示，CPP 水平较高（>中位数）和较低（<中位数）的患者在全因死亡方面没有显著差异。然而，CPP 较高的组心血管事件的发生率较高（对数秩检验 χ2=4.41，p=0.036）。单因素 Cox 回归分析显示，CPP 水平与全因死亡无关，但与心血管事件的发生率显著相关（危险比（HR）1.03，95%置信区间（CI）[1.02-1.05]，p<0.001），每增加 1000 个 CPP。多因素 Cox 回归分析显示，CPP 水平与全因死亡无关，但与心血管事件独立相关（HR 1.03，95% CI [1.01-1.04]，p<0.001），每增加 1000 个 CPP。
这一发现表明 CPP 在维持性血液透析患者中有潜在的预测价值。
