2nd Department of Internal Medicine and Nephrology, Diabetes Center, Clinical Centre, Medical School, University of Pécs, 7624 Pécs, Hungary.
National Dialysis Center Pécs, 7624 Pécs, Hungary.
Int J Mol Sci. 2024 Sep 30;25(19):10552. doi: 10.3390/ijms251910552.
IgA nephropathy (IgAN) is the most common primary glomerular disease. Endothelin-1 (ET-1) is one of the strongest vasoconstrictor materials in the blood. The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) is associated with renal function and poor outcomes in chronic kidney disease (CKD). Serum endocan is a biomarker associated with proinflammatory cytokines, and the increase in the serum level plays a critical role in inflammatory, proliferative, and neovascularization processes and is associated with poor cardiovascular outcomes in patients with CKD too. Identifying high-risk patients using biomarkers could help to optimize their treatment. Ninety patients with biopsy-confirmed IgAN were included in the study (50 males/40 females, mean age: 54.9 ± 14.4 years). Serum endocan, ET-1, and NT-proBNP were measured by enzyme-linked immunosorbent assay kits. Echocardiography was performed, and carotid-femoral pulse wave velocity (cfPWV) was measured by SphygmoCor in this cross-sectional study. Patients were divided into two groups based on serum endocan median level (cut-off: 44 ug/L). There was significantly higher aorta systolic blood pressure (SBPao) ( = 0.013), NT-proBNP ( = 0.028), albumin/creatinine ratio ( = 0.036), and uric acid ( = 0.045) in the case of the higher endocan group compared to the lower. There was also significantly higher SBPao ( = 0.037) and NT-proBNP ( = 0.038) in the case of higher endothelin-1 (ET-1) levels compared to the lower (cut-off: 231 pg/mL) group by the two-sample -test. Then, we divided the patients into two groups based on the eGFR (CKD 1-2 vs. CKD 3-5). The levels of serum endocan, NT-proBNP, cfPWV, SBPao, left ventricular mass index (LVMI), uric acid, and albuminuria were significantly higher in the CKD 3-5 group compared to the CKD 1-2 group. The serum endocan and NT-proBNP levels were significantly higher in the diastolic dysfunction group ( = 0.047, = 0.015). There was a significant increase in serum endocan levels (CKD 1 vs. CKD 5; = 0.008) with decreasing renal function. In IgAN, vascular biomarkers (endocan, ET-1) may play a role in endothelial dysfunction through vascular damage and elevation of SBPao. Serum endocan, ET-1, and NT-proBNP biomarkers may help to identify IgAN patients at high risk.
IgA 肾病 (IgAN) 是最常见的原发性肾小球疾病。内皮素-1 (ET-1) 是血液中最强的血管收缩物质之一。脑钠肽前体 (NT-proBNP) 的 N 端前体与慢性肾脏病 (CKD) 中的肾功能和不良预后相关。血清内皮细胞是与促炎细胞因子相关的生物标志物，其血清水平的升高在炎症、增殖和新生血管形成过程中起着关键作用，与 CKD 患者的不良心血管结局也有关。使用生物标志物识别高危患者有助于优化治疗。本研究纳入了 90 名经活检证实的 IgAN 患者（50 名男性/40 名女性，平均年龄：54.9±14.4 岁）。通过酶联免疫吸附试验试剂盒测量血清内皮素、ET-1 和 NT-proBNP。在这项横断面研究中，通过 SphygmoCor 进行了超声心动图检查，并测量了颈股脉搏波速度 (cfPWV)。根据血清内皮细胞中位水平（截距：44ug/L）将患者分为两组。与低内皮细胞组相比，高内皮细胞组的主动脉收缩压 (SBPao)（=0.013）、NT-proBNP（=0.028）、白蛋白/肌酐比值（=0.036）和尿酸（=0.045）明显更高。与低内皮素-1（ET-1）组相比（截距：231pg/mL），高内皮素-1（ET-1）组的 SBPao（=0.037）和 NT-proBNP（=0.038）也明显更高（两样本 t 检验）。然后，我们根据 eGFR（CKD 1-2 与 CKD 3-5）将患者分为两组。与 CKD 1-2 组相比，CKD 3-5 组的血清内皮细胞、NT-proBNP、cfPWV、SBPao、左心室质量指数（LVMI）、尿酸和蛋白尿明显更高。在舒张功能障碍组中，血清内皮细胞和 NT-proBNP 水平明显更高（=0.047，=0.015）。随着肾功能的下降，血清内皮细胞水平（CKD 1 与 CKD 5；=0.008）显著升高。在 IgAN 中，血管生物标志物（内皮素、内皮细胞）可能通过血管损伤和 SBPao 升高在血管内皮功能障碍中发挥作用。血清内皮细胞、内皮素-1 和 NT-proBNP 生物标志物有助于识别高危 IgAN 患者。
