慢性肾脏病中心脏生物标志物与心脏结构和功能的关联
Associations Between Cardiac Biomarkers and Cardiac Structure and Function in CKD.
作者信息
Stein Nathan R, Zelnick Leila R, Anderson Amanda H, Christenson Robert H, deFilippi Christopher R, Deo Rajat, Go Alan S, He Jiang, Ky Bonnie, Lash James P, Seliger Stephen L, Soliman Elsayed Z, Shlipak Michael G, Bansal Nisha
机构信息
Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
出版信息
Kidney Int Rep. 2020 May 7;5(7):1052-1060. doi: 10.1016/j.ekir.2020.04.031. eCollection 2020 Jul.
INTRODUCTION
Subclinical changes to cardiac structure and function detected with echocardiography precede the development of clinical heart failure (HF) in persons with chronic kidney disease (CKD). Circulating cardiac biomarkers may reflect these pathophysiological changes. This study investigated associations between established biomarkers (N-terminal pro-B-type natriuretic peptide [NT-proBNP] and high-sensitivity troponin T [hsTnT]) and novel biomarkers (growth differentiation factor 15 [GDF-15], galectin-3 [Gal-3], and soluble ST-2 [sST-2]), using echocardiographic measurements in persons with CKD.
METHODS
In cross-sectional analyses among 2101 participants with mild to moderate CKD in the Chronic Renal Insufficiency Cohort (CRIC), biomarker levels measured at baseline were evaluated with echocardiographic measurements 1 year later. These included left ventricular mass index (LVMI), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), and left atrial diameter (LAD). Multivariable linear regression analyses tested associations of each biomarker with echocardiographic measurements, adjusting for covariates.
RESULTS
GDF-15 was significantly associated with higher LVMI (1.0 g/m; 95% CI, 0.4-1.7), LVESV (0.4 ml/m; 95% CI, 0.0-0.7), and LVEDV (0.6 ml/m; 95% CI, 0.1-1.1), but not with LVEF or LAD. These findings were not significant when adjusting for NT-proBNP and hsTnT. Gal-3 and sST-2 had no significant associations. Higher levels of NT-proBNP and hsTnT were associated with all echocardiographic measurements.
CONCLUSION
In patients with CKD, the novel biomarker GDF-15, a marker of inflammation and tissue injury, and clinical biomarkers NT-proBNP and hsTnT, were associated with echocardiographic measurements of subclinical cardiovascular disease. Collectively, these biomarkers may highlight biological pathways that contribute to the development of clinical HF.
引言
在慢性肾脏病（CKD）患者中，超声心动图检测到的心脏结构和功能的亚临床变化先于临床心力衰竭（HF）的发生。循环心脏生物标志物可能反映这些病理生理变化。本研究利用CKD患者的超声心动图测量，调查了既定生物标志物（N末端B型利钠肽原[NT-proBNP]和高敏肌钙蛋白T[hsTnT]）与新型生物标志物（生长分化因子15[GDF-15]、半乳糖凝集素-3[Gal-3]和可溶性ST-2[sST-2]）之间的关联。
方法
在慢性肾功能不全队列（CRIC）中对2101例轻度至中度CKD参与者进行横断面分析，对基线时测量的生物标志物水平在1年后进行超声心动图测量评估。这些测量包括左心室质量指数（LVMI）、左心室收缩末期容积（LVESV）、左心室舒张末期容积（LVEDV）、左心室射血分数（LVEF）和左心房直径（LAD）。多变量线性回归分析检验了每种生物标志物与超声心动图测量之间的关联，并对协变量进行了调整。
结果
GDF-15与较高的LVMI（1.0 g/m；95%CI，0.4-1.7）、LVESV（0.4 ml/m；95%CI，0.0-0.7）和LVEDV（0.6 ml/m；95%CI，0.1-1.1）显著相关，但与LVEF或LAD无关。在对NT-proBNP和hsTnT进行调整后，这些发现无统计学意义。Gal-3和sST-2无显著关联。较高水平的NT-proBNP和hsTnT与所有超声心动图测量均相关。
结论
在CKD患者中，新型生物标志物GDF-15（一种炎症和组织损伤标志物）以及临床生物标志物NT-proBNP和hsTnT与亚临床心血管疾病的超声心动图测量相关。总体而言，这些生物标志物可能突出了导致临床HF发生的生物学途径。
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