Endogenous ouabain and cardiomyopathy in dialysis patients.
Endogenous ouabain and cardiomyopathy in dialysis patients.
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透析患者的内源性哇巴因和心肌病。
DOI：
10.1111/j.1365-2796.2007.01883.x
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发表时间：
2008
影响因子：
11.1
通讯作者：
Zoccali,C
中科院分区：
文献类型：
--
作者：
Stella,P;Manunta,P;Mallamaci,F;Melandri,M;Spotti,D;Tripepi,G;Hamlyn,JM;Malatino,LS;Bianchi,G;Zoccali,C
研究背景与方法。内源性瓦巴因（EO）在慢性肾功能衰竭患者中明显升高。由于高EO诱导体外心肌细胞肥厚，并与原发性高血压和心力衰竭患者的左心室肥厚（LVH）有关，我们研究了156例终末期肾病（ESRD）患者血浆EO与左心室质量和几何形状之间的关系。结果：在单因素分析中，血浆EO与左室质量（r= 0.26，P= 0.001）和左室舒张末期容积（r= 0.25，P= 0.002）直接相关，这些关系在包括一系列潜在混杂因素的多元线性回归模型中成立。偏心LVH患者（n= 41，即26%）的血浆EO水平高于其他类型LVH患者（P= 0.001）。此外，血浆EO对偏心性LVH具有诊断价值，因为相应ROC曲线下面积（68%）显著大于诊断无差异阈值（P= 0.002）。在本分析中，敏感性为91%，特异性为36%。结论：在ESRD患者中，血浆EO与左室质量、左室容积和偏心性LVH独立相关。本研究结果与EO参与ESRD左室质量改变的假设一致。
Background and methods.Endogenous ouabain (EO) is markedly raised in patients with chronic renal failure. As high EO induces myocardial cell hypertrophyin vitroand it is associated with left ventricular hypertrophy (LVH) in essential hypertensives and in patients with heart failure we investigated the relationship between plasma EO and LV mass and geometry in 156 end‐stage renal disease (ESRD) patients. EO was measured by a specific radioimmunoassay and by mass spectrometry.Results.On univariate analysis, plasma EO was directly related to LV mass (r= 0.26,P= 0.001) and LV end diastolic volume (r= 0.25,P= 0.002) and these relationships held true in multiple linear regression models including a series of potential confounders. Patients with eccentric LVH (n= 41, i.e. 26%) had the highest plasma levels of EO when compared to patients with other patterns of LV geometry (P= 0.001). Furthermore, plasma EO had diagnostic value for eccentric LVH because the area under the corresponding ROC curve (68%) was significantly greater (P= 0.002) than the threshold of diagnostic indifference. In this analysis, the sensitivity was 91% and the specificity was 36%. The positive predictive value was 33% but EO had a remarkably high negative predictive value (92%) for the exclusion of eccentric hypertrophy.Conclusions.In ESRD patients, plasma EO is independently associated with LV mass, LV volume and eccentric LVH. The results of this study are compatible with the hypothesis that EO is involved in alterations of LV mass in ESRD.