缺血修饰白蛋白对慢性肾脏病患者心血管事件的预测价值  

Predictive value of ischemia modified albumin for cardiovascular events in patients with chronic kidney disease

作　　者：苏晓燕[1] 丁苏[1] 邓惠钊 郑伟平[1] 邹原方[1] 李爱婷[1] 黄辉[2] 

机构地区：[1]中山大学附属东华医院肾内科,东莞523110 [2]中山大学孙逸仙纪念医院心内科,广州510120

出　　处：《中国血液净化》2016年第8期392-395,共4页Chinese Journal of Blood Purification

基　　金：国家自然科学基金优秀青年科学基金项目(项目编号:81422011);东莞市科技计划医疗卫生类科研一般项目(编号:201210515000387)

摘　　要：目的评价缺血修饰白蛋白（ischemia-modified albumin,IMA）对慢性肾脏病（chronic kidney disease,CKD）3~5期患者主要不良心血管事件（major adverse cardiovascular events,MACE）的预测价值。方法研究对象为慢性肾脏病3~5期未行肾脏替代治疗的患者213例,平均年龄（41.77±11.21）岁;收集患者基础资料、IMA及各项实验室指标,并对相关指标进行分析。结果依据血清IMA水平将CKD患者分为2组：正常IMA组[（IMA〈85k U/L,159例,（77.12±10.43）k U/L];高IMA组[IMA≥85k U/L,54例,（90.33±12.20）k U/L]。至随访结束时,高IMA组患者MACE发生19例,发生率为35.19%,远较正常IMA组高（33例,发生率20.75%;χ~2=4.549,P=0.033）。logistic回归分析显示IMA（OR1.104,95%CI 1.033~1.178,P=0.028）、超敏C反应蛋白（OR 1.232,95%CI 1.109~1.342,P=0.001）是CKD患者重要的心血管事件独立危险因素。生存分析显示高IMA组CKD患者无心血管事件生存率较正常IMA组低（Log-rank检验χ~2=15.830,P〈0.001）。结论 IMA升高的CKD患者MACE发生率较高,IMA是CKD患者重要的心血管事件独立危险因素,IMA可做为慢性肾脏病患者主要不良心血管事件的预测指标。Objective The aim of this study was to evaluate the efficiency of ischemia-modified albumin （//VIA） for predicting major adverse cardiovascular events （MACE） in chronic kidney disease （CKD） patients. Methods A total of 222 CKD patients were enrolled in this study. Baseline characteristics, IMA level and other laboratory measurements were collected and analyzed. The primary end point was the occurrence of MACE. Results A total of 213 participants finally completed this study, and 9 CKD patients were excluded because of dialysis treatment. They were divided into normal IMA group （IMA 〈85 KU/L, n=159, average IMA=77.12±10.43 KU/L） and high IMA group （IMA 〉85 KU/L, n=54, average IMA=90.33±12.20 KU/L）. At the end of follow-up, the prevalence of MACE was 20.75% （33 cases） in normal IMA group and was 35.19% （19 cases） in high IMA group （Z2=4.549, P=-0.033）. Logistic regression analysis showed that IMA （OR=1. 104, 95% CI 1.033-1.178;P=-0.028） and hs-CRP （OR=h232, 95% CI 1.109-1.342; P=0.001） were the indepen- dent risk factors for MACE in CKD patients. Kaplan-Meier survival analysis showed that the CKD patients with higher IMA level had lower non-MACE survival rate （Log-rank test, 2;=15.830, P〈0.001）, indicating that the CKD patients with higher IMA level have higher prevalence of MACE. Conclusions CKD patients with higher IMA level had higher prevalence of MACE. IMA was the independent risk factors for MACE. Therefore, IMA may be a predictive marker for MACE in CKD patients.

关 键 词：缺血修饰白蛋白 慢性肾脏病 主要不良心血管事件 预测价值 

分 类 号：R692.5[医药卫生—泌尿科学]