Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo 409-3898, Yamanashi, Japan.
Department of Internal Medicine II, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo 409-3898, Yamanashi, Japan.
J Cardiol. 2021 Aug;78(2):114-119. doi: 10.1016/j.jjcc.2021.02.006. Epub 2021 Apr 5.
Renal dysfunction, defined as a lower estimated glomerular filtration rate (eGFR), has been shown to be related to cardiovascular events in patients with myocardial infarction (MI). However, the contribution of renal tubulointerstitial damage to the predictive value for cardiovascular events has not been established. The aim of this study was to elucidate whether renal tubulointerstitial damage is associated with the occurrence of cardiac death and recurrence of MI in patients who have had MI.
Urinary β2-microglobulin (β2MG) was measured in 681 consecutive patients with MI in our hospital. All patients were followed up for <12 years or until the occurrence of cardiac death and MI. During a median follow-up period of 6 years, the cumulative cardiac death rate was 5.4%, and the MI rate was 3.1%. When outcomes were divided into two groups according to the β2MG levels, cardiac death and MI rates were lower in patients with lower levels of β2MG (<0.319 mg/gCre: determined by receiver operating characteristic analyses) than in those with β2MG ≥0.319 mg/gCre (5.9% versus 17.1%, p<0.01). When outcomes were stratified according to the β2MG levels in combination with eGFR levels, Kaplan-Meier analyses showed that cardiac death and MI rates increased depending on an increase in the β2MG levels (p<0.05). Moreover, multivariate Cox analyses revealed that high levels of β2MG were a significant independent predictor of adverse events (hazard ratio: 1.956; 95% confidence interval: 1.014-3.774; p = 0.045). The addition of high levels of β2MG to conventional risk factors, including eGFR and urinary albumin, improved the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI 0.5447, p = 0.0002; IDI 0.0126, p = 0.0454).
Renal tubulointerstitial damage, as assessed by urinary β2MG, is associated with the occurrence of cardiac death and recurrence of MI independent of renal glomerular function in patients with MI.
肾功能障碍（定义为估算肾小球滤过率[eGFR]降低）已被证实与心肌梗死（MI）患者的心血管事件相关。然而，肾小管间质损伤对心血管事件预测值的贡献尚未确定。本研究旨在阐明肾小管间质损伤是否与 MI 后患者的心脏死亡和 MI 复发有关。
在我院连续收治的 681 例 MI 患者中，测量了尿β2-微球蛋白（β2MG）。所有患者的随访时间<12 年或直至发生心脏死亡和 MI。在中位随访 6 年期间，累积心脏死亡率为 5.4%，MI 发生率为 3.1%。当根据β2MG 水平将结局分为两组时，β2MG<0.319mg/gCre（通过受试者工作特征分析确定）的患者心脏死亡和 MI 发生率低于β2MG≥0.319mg/gCre 的患者（5.9%比 17.1%，p<0.01）。当根据β2MG 水平结合 eGFR 水平分层时，Kaplan-Meier 分析显示，随着β2MG 水平的升高，心脏死亡和 MI 发生率增加（p<0.05）。此外，多变量 Cox 分析显示，高β2MG 水平是不良事件的显著独立预测因子（危险比：1.956；95%置信区间：1.014-3.774；p=0.045）。将高β2MG 水平与包括 eGFR 和尿白蛋白在内的传统危险因素相结合，可提高净重新分类改善（NRI）和综合判别改善（IDI）（NRI 0.5447，p=0.0002；IDI 0.0126，p=0.0454）。
通过尿β2MG 评估的肾小管间质损伤与 MI 患者的心脏死亡和 MI 复发有关，与肾脏肾小球功能无关。
