Biomarkers for the detection of renal fibrosis and prediction of renal outcomes: a systematic review.
Biomarkers for the detection of renal fibrosis and prediction of renal outcomes: a systematic review.
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DOI：
10.1186/s12882-017-0490-0
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发表时间：
2017-02-20
期刊：
影响因子：
2.3
通讯作者：
Parikh CR
中科院分区：
文献类型：
--
作者：
Mansour SG;Puthumana J;Coca SG;Gentry M;Parikh CR
纤维化是导致慢性肾脏疾病的统一途径。识别纤维化的生物标志物可能有助于预测疾病进展。我们进行了一项系统回顾，以评估血液和尿液生物标志物在识别活检纤维化以及预测肾脏结局方面的可靠性。使用MEDLINE和EMBASE，实施两阶段检索策略。阶段I鉴定了与活检纤维化相关的生物标志物库。II期评估了I期确定的生物标志物与肾脏结局之间的相关性。只有与纤维化中度正相关（r> 0.40）或曲线下面积可接受（AUC> 0.65）的生物标志物进入II期。第一阶段确定了17项研究和14种生物标志物。五种生物标志物符合进展到II期的标准，但只有三种与肾脏结局独立相关。转化生长因子β（TGF-β）与纤维化相关（r = 0.60），在426例患者中与肾功能恶化风险的1.7 - 3.9倍相关。单核细胞趋化蛋白-1（MCP-1）诊断纤维化的AUC为0.66，与596例患者肾功能恶化风险的2.3 - 11.0倍相关。基质金属蛋白酶-2（MMP-2）与纤维化相关（r = 0.41），与肾功能恶化风险的2.5倍相关。由于不同的患者人群沿着不同的肾脏结局，数据具有异质性，因此无法进行荟萃分析。尽管如此，我们可以从已发表的数据中得出结论，TGF-β、MCP-1和MMP-2可以识别出有肾纤维化风险的患者，因此肾脏结局更差。本文的在线版本（doi：10.1186/s12882 - 017 - 0490 - 0）包含补充材料，可供授权用户使用。
Fibrosis is the unifying pathway leading to chronic kidney disease. Identifying biomarkers of fibrosis may help predict disease progression. We performed a systematic review to evaluate the reliability of blood and urine biomarkers in identifying fibrosis on biopsy as well as predicting renal outcomes. Using MEDLINE and EMBASE, a two-stage search strategy was implemented. Stage I identified a library of biomarkers correlating with fibrosis on biopsy. Stage II evaluated the association between biomarkers identified in stage I, and renal outcomes. Only biomarkers with moderate positive correlation with fibrosis (r > 0.40) or acceptable area under the curve (AUC >0.65) advanced to stage II. Stage I identified 17 studies and 14 biomarkers. Five biomarkers met criteria to advance to stage II, but only three were independently associated with renal outcomes. Transforming growth factor β (TGF-β) correlated with fibrosis (r = 0.60), and was associated with 1.7–3.9 times the risk of worsening renal function in 426 patients. Monocyte chemoattractant protein-1 (MCP-1) diagnosed fibrosis with AUC of 0.66 and was associated with 2.3–11.0 times the risk of worsening renal function in 596 patients. Matrix metalloproteinase-2 (MMP-2) correlated with fibrosis (r = 0.41), and was associated with 2.5 times the risk of worsening renal function. Given the heterogeneity of the data due to diverse patient populations along with differing renal outcomes, a meta-analysis could not be conducted. Nonetheless we can conclude from the published data that TGF-β, MCP-1 and MMP-2 may identify patients at risk for renal fibrosis and hence worse renal outcomes. The online version of this article (doi:10.1186/s12882-017-0490-0) contains supplementary material, which is available to authorized users.