2nd. Department of Internal Medicine and Nephrology, Diabetes Center, Clinical Center, Medical School, University of Pécs, 7624 Pécs, Hungary.
Fresenius Medical Care Dialysis Center, 7624 Pécs, Hungary.
Int J Mol Sci. 2023 Jun 19;24(12):10336. doi: 10.3390/ijms241210336.
Cardiovascular mortality is a leading cause of death in chronic kidney disease (CKD), as is IgA nephropathy (IgAN). The purpose of this study is to find different biomarkers to estimate the outcome of the disease, which is significantly influenced by the changes in vessels (characterized by arterial stiffness) and the heart. In our cross-sectional study, 90 patients with IgAN were examined. The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was measured as a heart failure biomarker by an automated immonoassay method, while the carboxy-terminal telopeptide of collagen type I (CITP) as a fibrosis marker was determined using ELISA kits. Arterial stiffness was determined by measuring carotid-femoral pulse wave velocity (cfPWV). Renal function and routine echocardiography examinations were performed as well. Based on eGFR, patients were separated into two categories, CKD 1-2 and CKD 3-5. There were significantly higher NT-proBNP ( = 0.035), cfPWV ( = 0.004), and central aortic systolic pressure ( = 0.037), but not CITP, in the CKD 3-5 group. Both biomarker positivities were significantly higher in the CKD 3-5 group ( = 0.035) compared to the CKD 1-2 group. The central aortic systolic pressure was significantly higher in the diastolic dysfunction group ( = 0.034), while the systolic blood pressure was not. eGFR and hemoglobin levels showed a strong negative correlation, while left ventricular mass index (LVMI), aortic pulse pressure, central aortic systolic pressure, and cfPWV showed a positive correlation with NT-proBNP. cfPWV, aortic pulse pressure, and LVMI showed a strong positive correlation with CITP. Only eGFR was an independent predictor of NT-proBNP by linear regression analysis. NT-proBNP and CITP biomarkers may help to identify IgAN patients at high risk for subclinical heart failure and further atherosclerotic disease.
心血管死亡率是慢性肾脏病（CKD）的主要死亡原因，IgA 肾病（IgAN）也是如此。本研究的目的是寻找不同的生物标志物来估计疾病的结果，该结果受血管（以动脉僵硬为特征）和心脏变化的显著影响。在我们的横断面研究中，检查了 90 名 IgAN 患者。通过自动化免疫分析方法测量脑钠肽前体（NT-proBNP）作为心力衰竭的生物标志物，而使用 ELISA 试剂盒测定胶原 I 羧基末端肽（CITP）作为纤维化标志物。通过测量颈股脉搏波速度（cfPWV）来确定动脉僵硬。还进行了肾功能和常规超声心动图检查。根据 eGFR，将患者分为 CKD 1-2 期和 CKD 3-5 期。在 CKD 3-5 期组中，NT-proBNP（=0.035）、cfPWV（=0.004）和中心主动脉收缩压（=0.037）明显升高，但 CITP 没有。在 CKD 3-5 期组中，两种生物标志物的阳性率均明显高于 CKD 1-2 期（=0.035）。在舒张功能障碍组中，中心主动脉收缩压明显升高（=0.034），而收缩压则没有。eGFR 和血红蛋白水平呈强负相关，而左心室质量指数（LVMI）、主动脉脉搏压、中心主动脉收缩压和 cfPWV 与 NT-proBNP 呈正相关。cfPWV、主动脉脉搏压和 LVMI 与 CITP 呈强正相关。只有 eGFR 通过线性回归分析成为 NT-proBNP 的独立预测因子。NT-proBNP 和 CITP 生物标志物可能有助于识别 IgAN 患者亚临床心力衰竭和进一步动脉粥样硬化疾病的高危人群。
