高敏 C 反应蛋白在血液透析患者未来心血管事件中的作用。
Role of High-sensitivity C-reactive Protein in Future Cardiovascular Events in Hemodialysis Patients.
机构信息
Department of General Medicine, Hirosaki University Hospital, Hirosaki, Japan;
Department of Nursing Science, Hirosaki University Graduate School of Health Science, Hirosaki, Japan.
出版信息
In Vivo. 2024 May-Jun;38(3):1351-1358. doi: 10.21873/invivo.13575.
BACKGROUND/AIM: The pathogenesis of cardio-vascular disease (CVD) in hemodialysis (HD) patients involves inflammation and oxidative stress. High-sensitivity C-reactive protein (hs-CRP) is an established inflammatory biomarker associated with CVD. Several studies have suggested that the inflammatory biomarker pentraxin-3 (PTX-3) and the oxidative stress-related biomarker soluble lectin-like low-density lipoprotein receptor-1 (sLOX-1) are novel biomarkers for CVD in non-HD populations. This study aimed to clarify the association of these established and novel biomarkers with future cardiovascular (CV) events in HD patients.
PATIENTS AND METHODS
This was a single-center prospective cohort study that included 255 HD patients. The primary outcome was the composite of nonfatal and fatal CV events. The event-free survival rate between the two groups according to the median plasma level of each biomarker at baseline was evaluated using the Kaplan-Meier method. The risk for CV events at elevated levels of each biomarker was estimated using Cox proportional hazard model.
RESULTS
We observed 44 CV events during the median follow-up period of 743 days. The event-free survival rate significantly differed between the two groups in hs-CRP but not in PTX-3 or sLOX-1. The unadjusted hazard ratio (HR) for CV events in patients with hs-CRP levels above the median was 2.63 [95% confidence interval (CI)=1.37-5.02]. The HR remained significant after adjusting for age, sex, history of CVD, and diabetes (HR=2.30; 95%CI=1.20-4.43).
CONCLUSION
In HD patients, hs-CRP may have a predictable role for future CV events, whereas PTX-3 and sLOX-1 do not.
背景/目的：血液透析（HD）患者心血管疾病（CVD）的发病机制涉及炎症和氧化应激。高敏 C 反应蛋白（hs-CRP）是一种与 CVD 相关的已确立的炎症生物标志物。多项研究表明，炎症生物标志物五聚素 3（PTX-3）和与氧化应激相关的生物标志物可溶性凝集素样低密度脂蛋白受体-1（sLOX-1）是非 HD 人群 CVD 的新型生物标志物。本研究旨在阐明这些已确立和新型生物标志物与 HD 患者未来心血管（CV）事件的关系。
患者和方法
这是一项单中心前瞻性队列研究，纳入了 255 名 HD 患者。主要结局是无致死和致死性 CV 事件的复合结局。使用 Kaplan-Meier 法评估两组患者根据基线时每种生物标志物血浆中位数水平的无事件生存率。使用 Cox 比例风险模型估计每种生物标志物升高水平时发生 CV 事件的风险。
结果
在中位随访 743 天期间，观察到 44 例 CV 事件。hs-CRP 水平较高的两组之间的无事件生存率有显著差异，但 PTX-3 和 sLOX-1 则没有。hs-CRP 水平高于中位数的患者发生 CV 事件的未调整风险比（HR）为 2.63[95%置信区间（CI）=1.37-5.02]。调整年龄、性别、CVD 病史和糖尿病后，HR 仍有意义（HR=2.30；95%CI=1.20-4.43）。
结论
在 HD 患者中，hs-CRP 可能对未来 CV 事件具有预测作用，而 PTX-3 和 sLOX-1 则没有。
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