Bone Markers Predict Cardiovascular Events in Chronic Kidney Disease
Bone Markers Predict Cardiovascular Events in Chronic Kidney Disease
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DOI：
10.1359/jbmr.080610
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发表时间：
2008-11-01
影响因子：
6.2
通讯作者：
Malluche, Hartmut H.
中科院分区：
文献类型：
--
作者：
Fahrleitner-Pammer, Astrid;Herberth, Johann;Malluche, Hartmut H.
最近的研究表明，慢性肾脏病（CKD）患者的骨代谢和心血管事件之间存在联系。CKD是全球范围内的主要健康问题。本研究评估骨代谢的非侵入性标志物在预测心血管疾病（冠状动脉疾病）发病率中的作用。外周血管疾病、中风）和轻度至重度CKD患者的死亡率。在一项前瞻性队列研究中，筛选了627例CKD患者。为了关注骨代谢，排除了心血管事件的传统危险因素。对1.35例1-5期CKD患者进行了4年的随访。肾小球滤过率通过肾脏疾病饮食改良公式计算。甲状旁腺素（通过四种不同的测定法测量）、维生素D 25和1，25、骨特异性碱性磷酸酶（BSALP）、TRACP-5 b、骨钙素、血清胶原交联分子。测定RANKL和骨保护素。通过多变量logistic回归、Kaplan-Meier生存率和考克斯回归分析评估心血管事件的预测因素。共发生45起心血管事件（33%）。事件发生率分别为5.6%、29.1%。CKD 1-2、3、4、5期分别为45.2%、45.0%。在逻辑回归中，心血管事件仅通过（1）CKD分期（与年龄或性别无关，p < 0.001）;（2）BSALP（p = 0.03）;和（3）TRACP-5 b（p = 0.04）预测。骨形成标志物（BSALP）和骨吸收标志物（TRACP-5 b）可作为CKD患者心血管发病率和死亡率的预测因子。
Recent Studies have indicated a link between bone metabolism and cardiovascular events in patients with chronic kidney disease (CKD). CKD is a major health problem worldwide. This study evaluates the role of noninvasive markers of bone metabolism in predicting cardiovascular morbidity (coronary artery disease. peripheral vascular disease, stroke) and mortality in patients with mild to severe forms of CKD. In a prospective cohort study, 627 patients with CKD were screened. To focus on bone metabolism, traditional risk factors for cardiovascular events were excluded. and 1.35 patients with CKD stages 1-5 were followed for 4 yr. Glomerular filtration rate was calculated by the Modification of Diet in Renal Disease formula. PTH (measured by four different assays), vitamin D 25 and 1,25, bone-specific alkaline phosphatase (BSALP), TRACP-5b, osteocalcin, serum Collagen cross-link molecules. RANKL, and osteoprotegerin were determined. Predictors of cardiovascular events were evaluated by multivariable logistic regression, Kaplan-Meier survival, and Cox regression analysis. There were a total of 45 cardiovascular events (33%). Event rates were 5.6%, 29.1%. 45.2%, and 45.0%, In CKD stages 1-2, 3, 4, and 5, respectively. In logistic regression, cardiovascular events were predicted only by (1) CKD stage (independent of age or sex p < 0.001); (2) BSALP (p = 0.03); and (3) TRACP-5b (p = 0.04). Markers of bone formation (BSALP) and resorption (TRACP-5b) can serve as predictors of cardiovascular morbidity and mortality in CKD.