The Role of Vascular Biomarkers in Outcomes of Patients with Kidney Disease.
The Role of Vascular Biomarkers in Outcomes of Patients with Kidney Disease.
复制标题
血管生物标志物在肾病患者预后中的作用。
DOI：
10.1159/000533415
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发表时间：
2023
期刊：
影响因子：
2.5
通讯作者：
Mansour,SherryG
中科院分区：
文献类型：
--
作者：
Shi,Audrey;Mansour,SherryG
血管生物标志物可以解释急性肾损伤（阿基）和心血管疾病（CVD）等不良长期结局之间的联系。血管损伤在阿基中非常常见，并有助于肾纤维化和CVD的发展。血管生成素和其他重要的血管生物标志物作为体内血管稳定性的重要决定因素可以解释这种生物学联系。SummaryAngiopoietin-1（Angpt-1）通过减少炎症、细胞凋亡和血管通透性来促进血管稳定性。相比之下，血管生成素-2（Angpt-2）阻断Angpt-1与其受体的结合，从而导致血管不稳定性和渗透性。根据我们的研究结果，在阿基住院患者中，Angpt-1相对于Angpt-2水平较高与肾脏疾病进展、心力衰竭和死亡风险较低密切相关。在慢性肾脏疾病患者中，已显示肾小球血管系统中的内皮损伤触发Angpt-2分泌，导致不良结局，如CVD和死亡率。此外，在肾移植受者中，移植后Angpt-2水平显著降低，表明移植可降低Angpt-2水平并降低不良结局的发生率。其他血管健康途径-如血管内皮生长因子和胎盘生长因子-与有和无阿基的参与者心脏手术后生存率的提高有关。关键信息血管健康生物标志物为临床干预提供了可行的途径，以减少阿基患者的CVD和死亡率。未来的研究非常需要专注于开发强大的预后血管生物标志物面板，以帮助识别可能受益于有针对性的随访和治疗的高风险阿基幸存者，以预防肾脏和心脏并发症。
BackgroundVascular biomarkers may explain the link between acute kidney injury (AKI) and poor long-term outcomes such as cardiovascular disease (CVD). Vessel injury is exceedingly common in AKI and contributes to the development of kidney fibrosis and CVD. As prominent determinants of vessel stability in the body, angiopoietins and other prominent vascular biomarkers may explain this biological link.SummaryAngiopoietin-1 (Angpt-1) promotes vessel stability by decreasing inflammation, apoptosis, and vessel permeability. By contrast, angiopoietin-2 (Angpt-2) blocks the binding of Angpt-1 to its receptor and thus contributes to vessel instability and permeability. Based on our findings, higher levels of Angpt-1 relative to Angpt-2 were strongly associated with less risk of kidney disease progression, heart failure, and death in hospitalized patients with AKI. In chronic kidney disease patients, it has been shown that endothelial damage in glomerular vasculature triggers Angpt-2 secretion, leading to poor outcomes such as CVD and mortality. Furthermore, in kidney transplant recipients, Angpt-2 levels significantly decrease after transplantation suggesting that transplantation may reduce Angpt-2 levels and decrease rates of poor outcomes. Other vascular health pathways–such as vascular endothelial growth factor and placental growth factor–were associated with improved rates of survival after cardiac surgery in participants with and without AKI.Key MessagesVascular health biomarkers provide actionable pathways for clinical intervention in reducing CVD and mortality for AKI patients. There is great need for future research that focuses on developing robust prognostic vascular biomarker panels in order to help identify high-risk AKI survivors who may benefit from targeted follow-up and therapy, with the intention to prevent kidney and cardiac complications.