Kidney Health Research Collaborative, Department of Medicine, University of California San Francisco.
Department of Medicine, University of California San Francisco.
AIDS. 2024 Mar 15;38(4):465-475. doi: 10.1097/QAD.0000000000003761. Epub 2023 Oct 19.
The aim of this study was to determine whether urine biomarkers of kidney health are associated with subclinical cardiovascular disease among men with and without HIV.
A cross-sectional study within the Multicenter AIDS Cohort Study (MACS) among 504 men with and without HIV infection who underwent cardiac computed tomography scans and had urine biomarkers measured within the preceding 2 years.
Our primary predictors were four urine biomarkers of endothelial (albuminuria), proximal tubule dysfunction (alpha-1-microglobulin [A1 M] and injury (kidney injury molecule-1 [KIM-1]) and tubulointerstitial fibrosis (pro-collagen-III N-terminal peptide [PIIINP]). These were evaluated for association with coronary artery calcium (CAC) prevalence, CAC extent, total plaque score, and total segment stenosis using multivariable regression.
Of the 504 participants, 384 were men with HIV (MWH) and 120 were men without HIV. In models adjusted for sociodemographic factors, cardiovascular disease risk factors, eGFR, and HIV-related factors, each two-fold higher concentration of albuminuria was associated with a greater extent of CAC (1.35-fold higher, 95% confidence interval 1.11-1.65), and segment stenosis (1.08-fold greater, 95% confidence interval 1.01-1.16). Associations were similar between MWH and men without HIV in stratified analyses. The third quartile of A1 M showed an association with greater CAC extent, total plaque score, and total segment stenosis, compared with the lowest quartile.
Worse endothelial and proximal tubule dysfunction, as reflected by higher urine albumin and A1 M, were associated with greater CAC extent and coronary artery stenosis.
本研究旨在确定肾脏健康的尿液生物标志物是否与 HIV 感染者和非感染者的亚临床心血管疾病相关。
在多中心艾滋病队列研究（MACS）中进行的一项横断面研究，该研究纳入了 504 名 HIV 感染者和非感染者，他们在过去 2 年内接受了心脏计算机断层扫描，并测量了尿液生物标志物。
我们的主要预测指标是四种尿液生物标志物，分别反映了内皮功能（白蛋白尿）、近端肾小管功能障碍（α-1-微球蛋白 [A1M]）、损伤（肾损伤分子-1 [KIM-1]）和肾小管间质纤维化（前胶原-III N 端肽 [PIIINP]）。使用多变量回归评估这些标志物与冠状动脉钙化（CAC）患病率、CAC 程度、总斑块评分和总节段狭窄的相关性。
在 504 名参与者中，384 名为男性 HIV 感染者（MWH），120 名为男性非 HIV 感染者。在调整了社会人口因素、心血管疾病危险因素、eGFR 和 HIV 相关因素的模型中，白蛋白尿浓度增加两倍与 CAC 程度增加相关（增加 1.35 倍，95%置信区间为 1.11-1.65），与节段狭窄相关（增加 1.08 倍，95%置信区间为 1.01-1.16）。分层分析显示，MWH 和非 HIV 感染者之间的相关性相似。与最低四分位数相比，A1M 的第三四分位数与更大的 CAC 程度、总斑块评分和总节段狭窄相关。
尿液白蛋白和 A1M 反映的更严重的内皮和近端肾小管功能障碍与更大的 CAC 程度和冠状动脉狭窄相关。
