Prognostic Significance of Interleukin-34 (IL-34) in Patients With Chronic Heart Failure With or Without Renal Insufficiency.
Prognostic Significance of Interleukin-34 (IL-34) in Patients With Chronic Heart Failure With or Without Renal Insufficiency.
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白细胞介素 34 (IL-34) 对伴或不伴肾功能不全的慢性心力衰竭患者的预后意义
DOI：
10.1161/jaha.116.004911
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发表时间：
2017-04-01
影响因子：
5.4
通讯作者：
Yan X
中科院分区：
文献类型：
--
作者：
Tao R;Fan Q;Zhang H;Xie H;Lu L;Gu G;Wang F;Xi R;Hu J;Chen Q;Niu W;Shen W;Zhang R;Yan X
肾功能不全通常与心功能不全有关，对心力衰竭(HF)的不良长期结局具有预测价值。我们以前发现了一种新的肾脏生物标志物，白介素34(IL-34)，在心力衰竭患者中升高，并与心力衰竭期间的肾功能障碍和冠状动脉疾病相关。然而，IL-34在心力衰竭中的预后价值尚不清楚，因此本研究旨在确定它。这项前瞻性的观察性研究包括连续510名心力衰竭患者，他们的血清IL-34和其他变量在基线时进行了测量，并对他们进行了2年的跟踪调查。主要终点是心血管死亡或首次入院心衰，次要结果为心血管死亡、心衰住院和全因死亡。根据Kaplan-Meier曲线的对数等级检验，随着IL-34的增加，风险显著且逐渐增加。血清IL-34也是主要终点(1.301[1.115-1.518]；P=0.001)、心血管死亡(1.347[1.096-1.655]；P=0.005)、心力衰竭住院(1.234[1.018-1.494]；P=0.032)和全因死亡率(1.343[1.115-1.618]；P=0.002)在校正了年龄、性别、传统危险因素和N末端脑利钠肽原后，心力衰竭患者的对数IL-34水平按标准差增加。尤其是IL-34在有肾损害的心衰患者中的预后价值高于无肾损害的心衰患者。IL-34是慢性心力衰竭患者心血管死亡、心力衰竭住院和全因死亡的重要预测因子，特别是当合并肾功能不全时。血清IL-34检测可能提供新的见解，将肾损害与不良的心衰结局联系起来，超越其他肾脏标志物。
Renal dysfunction, commonly associated with cardiac dysfunction, has predictive value for adverse long‐term outcomes in heart failure (HF). We previously identified a novel renal biomarker, interleukin‐34 (IL‐34), elevated in HF patients and associated with kidney dysfunction and coronary artery disease during HF. However, the prognostic value of IL‐34 in HF remains unclear, so that the present study aimed to determine it. This prospective, observational study included 510 consecutive HF patients with their serum IL‐34 as well as other variables measured at baseline, and they were followed up for 2 years. The primary end point was a composite of cardiovascular death or a first HF hospitalization, with cardiovascular death, HF hospitalization, and all‐cause mortality as secondary outcomes. There was a significant and gradual increase in risk as IL‐34 increased, determined by log‐rank tests with Kaplan–Meier curves. Serum IL‐34 was also a significant prognostic predictor of the primary end point (1.301 [1.115–1.518]; P=0.001), cardiovascular death (1.347 [1.096–1.655]; P=0.005), HF hospitalization (1.234 [1.018–1.494]; P=0.032), and all‐cause mortality (1.343 [1.115–1.618]; P=0.002) in HF as per SD increase in the log IL‐34 level after adjusting for age, sex, traditional risk factors, and N‐terminal pro‐brain natriuretic peptide. Especially, IL‐34 had a more‐significant prognostic value in HF patients with kidney impairment than those without. IL‐34 is a significant predictor of cardiovascular death, HF hospitalization, and all‐cause mortality in chronic HF, especially when concomitant with renal dysfunction. Serum IL‐34 measurement may provide new insights linking kidney impairment to poor HF outcomes beyond other renal markers.