Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
Int J Cardiol. 2021 Sep 1;338:115-120. doi: 10.1016/j.ijcard.2021.06.041. Epub 2021 Jun 26.
Although urinary alpha-1-microglobulin has been used as a marker of tubular dysfunction, its clinical and prognostic values in patients with acute heart failure have not been validated.
We analyzed 623 patients (74 ± 13 years old, 60.0% male) with acute heart failure in whom urinary alpha-1-microglobulin (A1MG) levels were measured as tubular markers at the time of admission. The primary endpoint was all-cause mortality.
The median levels of urinary alpha-1-microglobulin with and without correction for urinary creatinine concentration were 8.80 (interquartile range: 4.20-17.7) mg/dL and 12.9 (5.92-30.7) mg/gCr, respectively. Urinary A1MG levels were significantly correlated with all of beta-2-microglobulin (r = 0.77), N-acetyl-β-D-glucosaminidase (r = 0.51), and estimated glomerular filtration rate (r = -0.42); however, alpha-1-microglobulin was most often predicted using beta-2-microglobulin or N-acetyl-β-D-glucosaminidase. During the 488-day (interquartile range: 185-938 days) follow-up, 141 deaths occurred. Higher A1MG levels were associated with higher mortality even after adjustment for other covariates. Only A1MG, but not beta-2-microglobulin or N-acetyl-β-D-glucosaminidase, yielded incremental prognostic information in addition to the preexisting prognostic factors (net-reclassification improvement: 0.254, P = 0.023; integrated discrimination improvement: 0.015, P = 0.028).
In patients hospitalized due to acute heart failure, urinary alpha-1-microglobulin was a marker of tubular dysfunction. High alpha-1-microglobulin was associated with all-cause mortality independent of glomerular function and was a better predictor of mortality than urinary beta-2-microglobulin.
尽管尿α-1-微球蛋白已被用作肾小管功能障碍的标志物，但它在急性心力衰竭患者中的临床和预后价值尚未得到验证。
我们分析了 623 名（74±13 岁，60.0%为男性）急性心力衰竭患者，这些患者在入院时测量了尿α-1-微球蛋白（A1MG）水平作为肾小管标志物。主要终点是全因死亡率。
未经尿肌酐浓度校正的尿α-1-微球蛋白中位数水平分别为 8.80（四分位间距：4.20-17.7）mg/dL 和 12.9（5.92-30.7）mg/gCr。尿 A1MG 水平与β-2-微球蛋白（r=0.77）、N-乙酰-β-D-氨基葡萄糖苷酶（r=0.51）和估算肾小球滤过率（r=-0.42）均显著相关；然而，α-1-微球蛋白最常通过β-2-微球蛋白或 N-乙酰-β-D-氨基葡萄糖苷酶来预测。在 488 天（四分位间距：185-938 天）的随访期间，发生了 141 例死亡。即使在调整其他协变量后，较高的 A1MG 水平也与更高的死亡率相关。仅 A1MG，而不是β-2-微球蛋白或 N-乙酰-β-D-氨基葡萄糖苷酶，在除现有预后因素之外还提供了额外的预后信息（净重新分类改善：0.254，P=0.023；综合判别改善：0.015，P=0.028）。
在因急性心力衰竭住院的患者中，尿α-1-微球蛋白是肾小管功能障碍的标志物。高α-1-微球蛋白与全因死亡率相关，独立于肾小球功能，并且是死亡率的更好预测指标，优于尿β-2-微球蛋白。
