Association of plasma neutrophil gelatinase-associated lipocalin with parameters of CKD-MBD in maintenance hemodialysis patients
Association of plasma neutrophil gelatinase-associated lipocalin with parameters of CKD-MBD in maintenance hemodialysis patients
复制标题
DOI：
10.1007/s00774-021-01248-9
复制
发表时间：
2021-08-15
影响因子：
3.3
通讯作者：
Xu, Dong-Mei
中科院分区：
文献类型：
--
作者：
Jia, Xiao-Yan;Wei, Kai;Xu, Dong-Mei
神经胶质明胶酶相关脂质运载蛋白（NGAL）不仅是肾损伤的生物标志物，也是参与代谢的骨源性因子。目的探讨维持性血液透析（MHD）患者血浆NGAL与慢性肾脏病-骨矿物质紊乱（CKD-MBD）参数之间的关系。材料与方法首先，对105例MHD患者进行横断面观察研究，探讨血浆NGAL水平与CKD-MBD参数之间的关系。第二，研究了12例MHD合并严重继发性甲状旁腺功能亢进（SHPT）患者行甲状旁腺切除和自体移植（PTX + AT）对血浆NGAL的影响。结果经斯皮尔曼相关分析，NGAL水平与女性呈正相关（r = 0.243，P = 0.012），年份（r = 0.290，P = 0.003），Klotho（r = 0.234，P = 0.016），钙（Ca）（r = 0.332，P = 0.001），碱性磷酸酶（ALP）（r = 0.401，P < 0.001）和全段甲状旁腺激素（iPTH）与血清白蛋白呈负相关（r =-0.201，P = 0.039）。调整年龄、性别、年龄、白蛋白和CKD-MBD的所有参数后钙、磷、碱性磷酸酶（ALP）、甲状旁腺素（iPTH）、成纤维细胞生长因子23（FGF 23）、NGAL与血清钙浓度呈正相关（r = 0.481，P < 0.001），P（r = 0.336，P = 0.037），lg（ALP）偏相关分析（r = 0.646，P < 0.001）;进一步多元线性回归分析显示，lg（NGAL）与Ca（Ⅱ）之间存在同样的正相关关系（β = 0.330，P = 0.002），P（β = 0.218，P = 0.037），lg（ALP）（β = 0.671，P < 0.001）。在PTX + AT后4-7天，血浆NGAL从715.84（578.73，988.14）至688.42（660.00，760.26）ng/mL（P = 0.071），Klotho从496.45（341.73，848.30）增加到1138.25（593.87，2009.27）pg/mL（P = 0.099）。结论MHD患者血浆NGAL水平与ALP水平呈正相关，重度SHPT患者PTX + AT治疗后NGAL水平呈下降趋势。这些结果表明NGAL是MHD条件下CKD-MBD的参与者。
Introduction Neutrophil gelatinase-associated lipocalin (NGAL) is not only a biomarker of kidney injury but also a bone-derived factor involved in metabolism. We aimed to explore relationships between plasma NGAL and chronic kidney disease-mineral bone disorder (CKD-MBD) parameters in maintenance hemodialysis (MHD) patients. Materials and methods First, a cross sectional observational study, including 105 MHD patients, was conducted to explore relationships between plasma NGAL levels and CKD-MBD parameters. Second, impact of parathyroidectomy and auto-transplantation (PTX + AT) on plasma NGAL was investigated in 12 MHD patients with severe secondary hyperparathyroidism (SHPT). Results According to Spearman correlation analysis, plasma NGAL levels were positively correlated with female (r = 0.243, P = 0.012), vintage (r = 0.290, P = 0.003), Klotho (r = 0.234, P = 0.016), calcium(Ca) (r = 0.332, P = 0.001), alkaline phosphatase (ALP) (r = 0.401, P < 0.001) and intact parathyroid hormone (iPTH) (r = 0.256, P = 0.008); while inversely correlated with albumin(Alb) (r = - 0.201, P = 0.039). After adjusting for age, sex, vintage, Alb and all parameters of CKD-MBD(Ca, P, lg(ALP), lg(iPTH), Klotho and fibroblast growth factor 23(FGF23)), lg(NGAL) were positively correlated with Ca (r = 0.481, P < 0.001), P (r = 0.336, P = 0.037), lg(ALP) (r = 0.646, P < 0.001) in Partial correlation analysis; further multiple linear regression analysis showed same positive associations between lg(NGAL) and Ca (beta = 0.330, P = 0.002), P (beta = 0.218, P = 0.037), lg(ALP) (beta = 0.671, P < 0.001). During the 4-7 days after PTX + AT, plasma NGAL decreased from 715.84 (578.73, 988.14) to 688.42 (660.00, 760.26) ng/mL (P = 0.071), Klotho increased from 496.45 (341.73, 848.30) to 1138.25 (593.87, 2009.27) pg/mL (P = 0.099). Conclusion Plasma NGAL levels were positively associated with ALP in MHD patients; and downtrends were shown after PTX + AT in patients with severe SHPT. These findings suggest that NGAL is a participant in CKD-MBD under MHD condition.