Strong predictive value of mannose-binding lectin levels for cardiovascular risk of hemodialysis patients.
Strong predictive value of mannose-binding lectin levels for cardiovascular risk of hemodialysis patients.
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DOI：
10.1186/s12967-016-0995-5
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发表时间：
2016-08-05
影响因子：
7.4
通讯作者：
Seelen MA
中科院分区：
文献类型：
--
作者：
Poppelaars F;Gaya da Costa M;Berger SP;Assa S;Meter-Arkema AH;Daha MR;van Son WJ;Franssen CF;Seelen MA
与一般人群相比，血液透析患者的心血管发病率和死亡率较高。甘露糖结合凝集素（MBL）在心血管疾病的发生发展中起重要作用。此外，血液透析改变MBL浓度和功能活动。本研究确定MBL水平对HD患者未来心脏事件（C事件）、心血管事件（CV事件）和全因死亡率的预测价值。我们对107例维持性血液透析患者进行了前瞻性研究。在一次透析前后测定血浆MBL、备解素、C3 d和sC 5 b-9。使用考克斯回归模型评价与未来C事件、CV事件和全因死亡率的相关性。在27个月的中位随访期间，36名参与者发生了21起C事件和36起CV事件，而37名患者死亡。在低MBL水平（<319 ng/mL，下四分位数）的患者中，C事件和CV事件的发生率显著较高。在完全校正的模型中，低MBL水平与CV事件（风险比3.98; 95% CI 1.88-8.24; P < 0.001）和C事件（风险比3.96; 95% CI 1.49-10.54; P = 0.006）增加独立相关。未发现低MBL水平与全因死亡率之间存在关联。此外，MBL大大改善了CV事件的风险预测，超过了目前使用的临床标志物。低MBL水平与未来C事件和CV事件的风险较高相关。因此，MBL水平可能有助于确定血液透析患者是否有发生心血管疾病的风险。本文的在线版本（doi：10.1186/s12967-016-0995-5）包含补充材料，可供授权用户使用。
Hemodialysis patients have higher rates of cardiovascular morbidity and mortality compared to the general population. Mannose-binding lectin (MBL) plays an important role in the development of cardiovascular disease. In addition, hemodialysis alters MBL concentration and functional activity. The present study determines the predictive value of MBL levels for future cardiac events (C-event), cardiovascular events (CV-event) and all-cause mortality in HD patients. We conducted a prospective study of 107 patients on maintenance hemodialysis. Plasma MBL, properdin, C3d and sC5b-9 was measured before and after one dialysis session. The association with future C-events, CV-events, and all-cause mortality was evaluated using Cox regression models. During median follow-up of 27 months, 36 participants developed 21 C-events and 36 CV-events, whereas 37 patients died. The incidence of C-events and CV-events was significantly higher in patients with low MBL levels (<319 ng/mL, lower quartile). In fully adjusted models, low MBL level was independently associated with increased CV-events (hazard ratio 3.98; 95 % CI 1.88–8.24; P < 0.001) and C-events (hazard ratio 3.96; 95 % CI 1.49–10.54; P = 0.006). No association was found between low MBL levels and all-cause mortality. Furthermore, MBL substantially improved risk prediction for CV-events beyond currently used clinical markers. Low MBL levels are associated with a higher risk for future C-events and CV-events. Therefore, MBL levels may help to identify hemodialysis patients who are at risk to develop cardiovascular disease. The online version of this article (doi:10.1186/s12967-016-0995-5) contains supplementary material, which is available to authorized users.