慢性肾脏病患者血清胎盘生长因子水平及其与左心室结构和功能的关系

Relationship between serum level of placental growth factor and left ventricular structure and function in chronic kidney disease patients

目的探讨慢性肾脏病（CKD）患者血清胎盘生长因子（placental growth factor，PLGF）水平及其与左心室结构和功能的关系。方法选取CKD非透析患者72例，年龄、性别相匹配的健康体检者16例作为对照组。采用酶联免疫吸附法测定血清PLGF浓度，心脏超声评定心脏形态和结构。结果（1）CKD患者血清PLGF显著高于对照组[3．32（2．97，19．77）ng／L比2．33（2．27，2．49）ng／L，P〈0．01]；且随着肾功能的减退，PLGF水平进行性升高（P〈0．05／6）。（2）CKD各期患者的室间隔厚度（IVST）和左室后壁厚度（LVPWT）升高，射血分数（EF）下降。（3）CKD患者左心室肥厚组血清PLGF显著高于非左心室肥厚组[19．05（3.31，21．05）ng／L比2．99（2．60，3．32）ng／L，P〈0．05]。PLGF高浓度组左室肥厚发生率显著高于PLGF低浓度组（70％比18％，P〈0．01）。（4）相关分析显示PLGF与左心室质量指数、收缩压、舒张压、24h尿蛋白、血肌酐（Scr）、血尿酸（UA）、血尿素氮（BUN）、甲状旁腺激素（iPTH）、高血压病史呈正相关（P〈0．05），与左心室射血分数、血红蛋白（Hb）、血白蛋白（Alb）、肾小球滤过率（eGFR）呈负相关（P〈0．01）。多元线性逐步回归分析显示，血肌酐、血红蛋白、射血分数、血尿酸是PLGF的独立相关因素（P〈0．05）。结论CKD患者血清PLGF显著升高，PLGF与CKD患者心脏结构和功能改变密切相关，其可能参与CKD患者心血管事件的发生。

Objective To investigate the serum level of placental growth factor （PLGF） and explore its relationship with left ventricular structure and function in chronic kidney disease （CKD） patients. Methods Seventy- two non-dialysis CKD patients and sixteen age- and sexmatched healthy controls were included in this study. Serum PLGF level was measured by ELISA. Cardiac structure and function were assessed by two dimensional echocardiography. Results （1）The serum level of PLGF in CKD patients[3.32（2.97, 19.77） ng/L] was significantly higher compared to the healthy controls [2.33（2.27, 2.49） ng/L] （P 〈 0.01）. It progressively increased with the decline of renal function （P〈 0.05/6）. （2）The interventricular septum 0VS）, left ventricular posterior wall （LVPW） was significantly higher while the ejection fraction was significantly lower in CKD patients. （3）The serum PLGF level was higher in patients with left ventricular hypertrophy （LVH） than those without LVH [19.05（3.31, 21.05） ng/L vs 2.99（2.60, 3.32） ng/L, P 〈 0.05]. The prevalence of LVH in the group above median PLGF level was significantly higher than that in the group below the median PLGF level （70% vs 18%, P 〈 0.01）. （4）PLGF level was positively correlated with left ventricular mass index （LVMI）,systolic pressure, diastolic pressure, 24 h urine protein, Scr, UA, BUN, iPTH, the history of high blood pressure and was negatively correlated with LVEF, hemoglobin, albumin, eGFR （P 〈 0,05）. Multiple regression results showed that UA, Scr, LVEF, Hb were associated with PLGF level independently （P 〈 0.01）. Conclusions CKD patients have elevated level of PLGF. It has a relationship with cardiac structure and function. It may participate in the occurrence of cardiovascular events.