Okasha Kamal M, Aboufreikha Mohamed Hussein, Elrefaey Waleed, Ashmawy Medhat M, Mourad Heba, Elsebaey Mohamed A, Elnaggar Mohammed H, Mashaal Raghda Gabr, Metwally Sama, Mashal Shaimaa Samir Amin, Shalaby Neveen A, Elhoseny Shireen Ali, Alkassas Amr, Elbarbary Mohammed, Shoeib Osama, Ali Dina A, Baiomy Nivin, Alnabawy Sherein M
Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Cardiovascular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Front Med (Lausanne). 2022 Jun 22;9:814970. doi: 10.3389/fmed.2022.814970. eCollection 2022.
Chronic kidney disease has emerged as a significant independent risk factor for cardiovascular disease. Cardiovascular calcification is an active process involving a complex interaction of inducers and inhibitors. High sensitivity cardiac troponin T assay detects troponin T with higher sensitivity and precision at an earlier point of time than the conventional assays, and is associated with poor outcomes. Serum osteoprotegerin is classed as an inhibitory factor for cardiovascular calcification. It is involved in the pathological processes of vascular damage and linked to the excess cardiovascular morbidity. The aim of the present study was to evaluate the extent of cardiovascular calcification and serum high sensitivity cardiac troponin T level, and their association with serum osteoprotegerin level in patients with chronic kidney disease stages 3-5.
90 chronic kidney disease patients were enrolled in this study, and they were divided into two groups: group (1) included 45 non-dialysis-dependent chronic kidney disease patients (stages 3-5) and group (2) included 45 chronic hemodialysis patients. Each group further subdivided according to the presence of cardiovascular calcification into subgroup A and B. Vascular calcifications were assessed by lateral lumbar, pelvis and hands X-ray radiographs. Valvular calcification was assessed by echocardiography. Serum cardiac troponin T was measured by high sensitivity assay and serum osteoprotegerin was measured by ELISA.
Cardiovascular calcification distribution was 22.2% in group (1) and 33.3% in group (2). Serum osteoprotegerin and troponin T in calcification groups (1A and 2A) were significantly higher than non-calcification groups (1B and 2B; < 0.001). Osteoprotegerin correlated positively with high sensitivity cardiac troponin T (rs = 0.72, < 0.001). cardiovascular calcification correlated positively with osteoprotegerin, troponin T, and phosphorus. osteoprotegerin and phosphorus were significant independent predictors of cardiovascular calcification at cut-off values ≥4.6 ng/L and ≥6.95 mg/dl, respectively ( < 0.001). Serum phosphorus and creatinine were independent predictors of osteoprotegerin ( < 0.001 and 0.048, respectively).
Osteoprotegerin is strongly associated with cardiovascular calcification and high sensitivity cardiac troponin T. In addition, there is a positive association between calcification and troponin T. This suggests a role for osteoprotegerin in the pathogenesis and risk stratification of cardiovascular calcification and myocardial injury in chronic kidney disease patients with a potential role as a therapeutic target.
慢性肾脏病已成为心血管疾病的一个重要独立危险因素。心血管钙化是一个涉及诱导剂和抑制剂复杂相互作用的活跃过程。高敏心肌肌钙蛋白T检测比传统检测方法能在更早时间点以更高的灵敏度和精密度检测到肌钙蛋白T，且与不良预后相关。血清骨保护素被归类为心血管钙化的抑制因子。它参与血管损伤的病理过程，并与心血管疾病发病率过高有关。本研究的目的是评估3 - 5期慢性肾脏病患者心血管钙化程度、血清高敏心肌肌钙蛋白T水平及其与血清骨保护素水平的关系。
90例慢性肾脏病患者纳入本研究，分为两组：（1）组包括45例非透析依赖的慢性肾脏病患者（3 - 5期），（2）组包括45例慢性血液透析患者。每组再根据是否存在心血管钙化进一步分为A、B亚组。通过腰椎侧位、骨盆和手部X线片评估血管钙化。通过超声心动图评估瓣膜钙化。采用高敏检测法测定血清心肌肌钙蛋白T，采用酶联免疫吸附测定法测定血清骨保护素。
（1）组心血管钙化分布为22.2%，（2）组为33.3%。钙化组（1A和2A）的血清骨保护素和肌钙蛋白T显著高于非钙化组（1B和2B；P < 0.001）。骨保护素与高敏心肌肌钙蛋白T呈正相关（rs = 0.72，P < 0.001）。心血管钙化与骨保护素、肌钙蛋白T和磷呈正相关。骨保护素和磷分别在截断值≥4.6 ng/L和≥6.95 mg/dl时是心血管钙化的显著独立预测因子（P < 0.001）。血清磷和肌酐是骨保护素的独立预测因子（分别为P < 0.001和0.048）。
骨保护素与心血管钙化和高敏心肌肌钙蛋白T密切相关。此外，钙化与肌钙蛋白T之间存在正相关。这表明骨保护素在慢性肾脏病患者心血管钙化和心肌损伤的发病机制及风险分层中起作用，可能作为治疗靶点。
