慢性肾脏病患者血清中性粒细胞明胶酶相关载脂蛋白与心血管事件相关性分析  

Relationship between serum neutrophil gelatinase-associated apolipoprotein and cardiovascular events in patients with chronic renal disease

作　　者：龚淑文[1] 谢海英[1] 官继超[1] 单娟萍[1] 沈水娟[1] 何剑零[1] 李青华[1] 王时敏[1] 龚屠健 张素梅 Gong Shuwen;Xie Haiying;Guan Jichao;Shan Juanping;Shen Shuijuan;He Jianling;Li Qinghua;Wang Shimin;Gong Tujian;Zhang Sumei(Department of Nephrology,Shaoxing People's Hospital,Shaoxing Hospital,Zhejiang University School of Medicine,Shaoxing 312000,China)

机构地区：[1]绍兴市人民医院浙江大学绍兴医院肾内科,312000

出　　处：《中华内分泌外科杂志》2019年第2期154-158,共5页Chinese Journal of Endocrine Surgery

基　　金：浙江省医药卫生科研项目(2016KYB303);绍兴市科技计划项目(2015B70050).

摘　　要：目的探讨慢性肾脏病(chronic kidney disease,CKD)患者中性粒细胞明胶酶相关载脂蛋白(serum neutrophil gelatinase-associated lipocalin,sNGAL)与心血管事件相关性。方法选取2016年1月至2017年12月期间浙江绍兴市人民医院收治的300例CKD患者为研究对象,根据sNGAL水平分为高sNGAL组(n=158)和低sNGAL(n=142)组,比较两组一般资料、心血管事件发生率及累积生存率,采用ROC曲线分析检测方法效率,并分析sNGAL与心血管危险因素相关性,CKD患者心血管事件影响因素。结果两组身体质量指数(body mass index,BMI)、糖尿病比例、CKD分期、肾小球滤过率(glomerular filtration rate,eGFR)、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、24 h蛋白尿、高密度脂蛋白(high density lipoprotein,HDL)、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、磷酸盐及血钙比较,差异均有统计学意义(P<0.05);高sNGAL组3年累积生存率(77.2%)显著低于低sNGAL组(96.5%),3年心血管事件发生率(37.9%)显著高于低sNGAL组(9.8%)(P<0.05);sNGAL诊断心血管事件AUC值(area under curve,AUC)(0.746)显著大于eGFR(0.636)、年龄(0.504)、血钙(0.545)、HDL(0.594)和低密度脂蛋白(low density lipoprotein,LDL)(0.508)(均P<0.05);sNGAL与eGFR、HDL、BMI、hs-CRP、iPTH和磷酸盐有显著相关性(P<0.05);比例风险回归模型(proportional hazards model,COX)单因素和多因素均显示sNGAL是CKD患者心血管事件影响因素,风险比(hazard ratio,HR)分别是1.976和1.588,95%置信区间(confidence interval,CI)分别是1.443~2.724和1.144~2.143,P分别为0.000和0.000。结论高sNGAL的CKD患者心血管事件的发生率显著升高,sNGAL是CKD患者心血管事件的独立影响因素。Objective To investigate the relationship between (serum neutrophil gelatinase-associated lipocalin, sNGAL) and cardiovascular events in patients with chronic kidney disease (CKD). Methods 300 patients with CKD were divided into two groups according to the level of sNGAL: high sNGAL group (n=158) and low sNGAL group (n=142). The incidence of cardiovascular events and cumulative survival rate were analyzed by ROC curve, and the correlation between sNGAL and cardiovascular risk factors, cardiovascular events in patients with chronic renal disease was analyzed. Influencing factors of cardiovascular events in CKD patients was analyzed. Results There were significant differences in the data about BMI, diabetes proportion, CKD staging, eGFR, hs-CRP, 24h proteinuria, HDL, iPTH, phosphate and blood calcium between the two groups (P<0.05). The 3-year cumulative survival rate of high sNGAL group (77.2%) was significantly lower than that of low sNGAL group (96.5%), and the 3-year incidence of cardiovascular events (37.9%) was significantly higher than that of low sNGAL group (9.8%)(P< 0.05). AUC in diagnosing cardiovascular events in high sNGAL group (0.746) was significantly higher than that in eGFR (0.636), age (0.504), serum calcium (0.545), HDL (0.594) and LDL (0.508, all P<0.05). There was a significant correlation between sNGAL and eGFR, HDL, BMI, hs-CRP, iPTH and phosphate (P<0.05). Both univariate and multivariate factors COX showed that sNGAL was a risk factor of cardiovascular events in patients with CKD (P<0.05),((HR=1.976 and 1.588, 95% CI=1.443-2.724 and 1.144-2.143, respectively, P=0.000 and 0.000)). Conclusions The incidence of cardiovascular events in patients with CKD with high sNGAL is significantly increased. sNGAL is an independent factor of cardiovascular events in patients with chronic renal disease.

关 键 词：慢性肾脏病 中性粒细胞明胶酶相关载脂蛋白 心血管事件 

分 类 号：R692[医药卫生—泌尿科学]