Internal Medicine and Nephrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Internal Medicine and Nephrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Clin Investig Arterioscler. 2022 Mar-Apr;34(2):75-85. doi: 10.1016/j.arteri.2021.11.004. Epub 2022 Feb 8.
Chronic hemodialysis (HD) patients are among the highest population risk for accelerated atherosclerosis. Osteopontin (OPN) is a multifunctional protein that is increased in chronic kidney disease that may play a role in vascular remodelling and intimal proliferation.
To assess the relation between OPN levels and severity of carotid atherosclerosis among prevalent HD patients.
Eighty chronic HD patients underwent serum OPN levels assessment and were further classified into 3 subgroups according to the OPN tertiles' levels; sub-group 1 (lower tertile) subgroup 2 (middle tertile) and sub-group 3 (upper tertile), together with the carotid duplex and Transthoracic Doppler Echocardiography examination.
The mean carotid intima-media thickness (CIMT) was 0.89±0.14mm. Out of the studied group, 50 (62.5%) patients had atheromatous plaques and 15 patients (18.8%). had significant stenosis. The 3rd group with the upper OPN tertile (78-270ng/dl) had the highest incidence of atherosclerosis. A significant correlation between the OPN levels and the CIMT (r=0.533, p=0.001). OPN values detect atherosclerosis with diagnostic sensitivity of 70%, specificity of 69%, positive predictive value (PPV) 73%, negative predictive value (NPV) 65% with area under the curve (AUC) 0.804 (95% CI: 0.711-0.897). Serum OPN detect carotid stenosis with sensitivity of 66%, specificity of 81%, PPV 45%, NPV 91% with AUC=0.769 and detect the presence of carotid atheroma with sensitivity 70%, specificity 66.67%, PPV 77.8%, NPV 57.1% and AUC=0.767 (p-value<0.001). Moreover, serum levels of OPN were significantly positively correlated with grade of diastolic dysfunction (r=0.312, p=0.005), E/A ratio (r=0.293, p=0.008) and inversely correlated with left ventricular ejection fraction (r=-0.304, p=0.006).
Serum Osteopontin is of clinical value as a predictor biomarker of the severity of carotid atherosclerosis, presence of atheroma and carotid stenosis with high diagnostic sensitivity and specificity in chronic hemodialysis patients. Increased Osteopontin level is associated with left ventricular diastolic and systolic dysfunction in those patients.
慢性血液透析（HD）患者是发生动脉粥样硬化加速的最高危人群之一。骨桥蛋白（OPN）是一种在慢性肾脏病中增加的多功能蛋白，可能在血管重塑和内膜增殖中发挥作用。
评估在现患 HD 患者中 OPN 水平与颈动脉粥样硬化严重程度之间的关系。
80 名慢性 HD 患者接受血清 OPN 水平评估，并根据 OPN 三分位水平进一步分为 3 个亚组；亚组 1（低三分位）、亚组 2（中三分位）和亚组 3（高三分位），同时进行颈动脉双功超声和经胸多普勒超声心动图检查。
颈动脉内膜中层厚度（CIMT）的平均值为 0.89±0.14mm。在研究组中，50 名（62.5%）患者有动脉粥样硬化斑块，15 名（18.8%）患者有显著狭窄。OPN 三分位的第 3 组（78-270ng/dl）的动脉粥样硬化发生率最高。OPN 水平与 CIMT 呈显著正相关（r=0.533，p=0.001）。OPN 值检测动脉粥样硬化的诊断灵敏度为 70%，特异性为 69%，阳性预测值（PPV）为 73%，阴性预测值（NPV）为 65%，曲线下面积（AUC）为 0.804（95%CI：0.711-0.897）。血清 OPN 检测颈动脉狭窄的灵敏度为 66%，特异性为 81%，PPV 为 45%，NPV 为 91%，AUC=0.769，检测颈动脉粥样硬化的灵敏度为 70%，特异性为 66.67%，PPV 为 77.8%，NPV 为 57.1%，AUC=0.767（p 值<0.001）。此外，血清 OPN 水平与舒张功能不全程度呈显著正相关（r=0.312，p=0.005），与 E/A 比值呈显著正相关（r=0.293，p=0.008），与左心室射血分数呈显著负相关（r=-0.304，p=0.006）。
血清骨桥蛋白作为预测标志物，在慢性血液透析患者中具有预测颈动脉粥样硬化严重程度、存在动脉粥样硬化和颈动脉狭窄的临床价值，具有较高的诊断灵敏度和特异性。OPN 水平升高与左心室舒张和收缩功能障碍有关。
