Advanced oxidation protein products as risk factors for atherosclerotic cardiovascular events in nondiabetic predialysis patients
Advanced oxidation protein products as risk factors for atherosclerotic cardiovascular events in nondiabetic predialysis patients
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DOI：
10.1053/j.ajkd.2004.09.011
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发表时间：
2005-01-01
影响因子：
13.2
通讯作者：
Jungers, P
中科院分区：
文献类型：
--
作者：
Descamps-Latscha, A;Witko-Sarsat, V;Jungers, P
背景：炎症和氧化应激是动脉粥样硬化的危险因素，但它们是否促进了与慢性肾脏疾病(CKD)相关的动脉粥样硬化的加速形成，在透析前阶段仍有待评估。方法：我们前瞻性地研究了80例尿毒症透析前患者的血浆C-反应蛋白(CRP)、纤维蛋白原和晚期氧化蛋白产物(AOPPs)水平与首次发生闭塞性动脉粥样硬化性心血管事件(ASCVEs)的关系，这些指标是炎症和氧化应激的选择性标志物。结果：在随访期间(中位数7年)，21名患者发生了冠状动脉、脑或外周动脉闭塞事故，发生率为44/1000人年。除了年龄较大外，他们的传统危险因素与59名没有发生此类事故的患者没有什么不同。相反，尽管两组间血清肌酐水平无差异，但两组患者的C反应蛋白(4.3+/-2.7vs2.3+/-2 mg/L；P=0.005)、纤维蛋白原(5.6+/-1.4vs4.4+/-1.2 mg/L；P=0.0009)和AOPPS(58/-20vs42+/-14mumol/L；P=0.0002)水平显著升高。经多因素Cox回归分析，年龄、C反应蛋白、纤维蛋白原和AOPP水平是ASCVEs的显著独立预测因素。危险因素调整后的危险比如下：年龄1.13(95%可信区间1.04~1.22；P=0.002)；C反应蛋白水平1.37(95%可信区间1.05~1.79；P=0.02)；纤维蛋白原水平2.23(95%可信区间1.2~4.13；P=0.011)；AOPP水平1.68(95%可信区间1.12~2.51；P=0.011)。结论：C反应蛋白、纤维蛋白原和AOPP水平独立预测CKD患者透析前的ASCVEs，并可能直接参与尿毒症相关动脉粥样硬化的加速形成。(C)2004年，由国家肾脏基金会公司提供。
Background: Inflammation and oxidative stress are established risk factors for atherosclerosis, but whether they contribute to the accelerated atherogenesis associated with chronic kidney disease (CKD) remains to be assessed at the predialysis stage. Methods: We prospectively examined the relationship between plasma levels of C-reactive protein (CRP), fibrinogen, and advanced oxidation protein products (AOPPs), as selected markers of inflammation and oxidative stress, and incident first occlusive atherosclerotic cardiovascular (CV) events (ASCVEs) in a single-center cohort of 80 uremic predialysis patients without diabetes with a creatinine clearance ranging from 20 to 40 mL/min/1.73 m(2). Results: During follow-up (median, 7 years), 21 patients developed coronary, cerebral, or peripheral artery occlusive accidents, an incidence of 44/1,000 patient-years. Except for older age, their conventional risk factors did not differ compared with the 59 patients who remained free of such accidents. Conversely, plasma levels of CRP (4.3 +/- 2.7 versus 2.3 +/- 2 mg/L; P = 0.005), fibrinogen (5.6 +/- 1.4 versus 4.4 +/- 1.2 mg/L; P = 0.0009), and AOPPs (58 +/- 20 versus 42 +/- 14 mumol/L; P = 0.0002) were significantly greater at baseline, although serum creatinine levels did not differ between the 2 groups. By multivariate Cox regression analysis, age and CRP, fibrinogen, and AOPP levels were significant independent predictors of ASCVEs. Risk factor-adjusted hazard ratios were as follows: age, 1.13 (95% confidence interval, 1.04 to 1.22; P = 0.002); CRP level, 1.37 (95% confidence interval, 1.05 to 1.79; P = 0.02); fibrinogen level, 2.23 (95% confidence interval, 1.20 to 4.13; P = 0.011); and AOPP level, 1.68 (95% confidence interval, 1.12 to 2.51; P = 0.011). Conclusion: CRP, fibrinogen, and AOPP levels independently predict ASCVEs in patients with CKD in the predialysis phase and might directly contribute to the uremia-associated accelerated atherogenesis. (C) 2004 by the National Kidney Foundation, Inc.