klotho蛋白在心力衰竭合并肾损伤中的表达及其临床意义

Expression and Clinical Significance of Klotho Protein in Heart Failure Complicated with Renal Injury

目的探讨心力衰竭合并肾损伤患者血清klotho蛋白的表达情况,分析其与肾功能损害的相关性。方法选择2009年8月—2014月8月收治的心力衰竭134例,分为心力衰竭组71例和心肾综合征组63例,选取同期健康人60例作为对照组。观察心力衰竭患者心功能情况,检测3组肾功能,分析心力衰竭患者血清klotho蛋白的表达与肾功能的相关性。结果心肾综合征组左心室舒张末期内径(LVDd)高于心力衰竭组,左心室射血分数(LVEF)低于心力衰竭组(P<0.05);两组纽约心脏病协会心功能分级比较差异具有统计学意义(P<0.05)。心肾综合征组血肌酐(Scr)、尿微量白蛋白(m ALB)、胱抑素C(Cys-C)、ɑ_1微球蛋白(ɑ_1-MG)、β_2微球蛋白(β_2-MG)、尿免疫球蛋白G(Ig G)、血清和尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)高于心力衰竭组和对照组,klotho蛋白低于心力衰竭组和对照组(P<0.05);心力衰竭组m ALB、Cys-C、ɑ_1-MG、β_2-MG、尿Ig G、血清和尿NGAL值高于对照组,klotho蛋白低于对照组(P<0.05)。心力衰竭患者血清klotho蛋白表达与Scr、m ALB、Cys-C、ɑ_1-MG、β_2-MG、尿Ig G、血清和尿NGAL均呈负相关关系(P<0.05,P<0.01)。结论心力衰竭合并肾功能损害患者的血清klotho蛋白水平显著降低。血清klotho蛋白水平测定可以作为评价心力衰竭合并肾损伤患者病情程度的指标。

Objective To investigate the expression of serum Klotho protein in patients with heart failure complicated with renal injury and to study its correlation with renal function injury. Methods A total of 134 heart failure patients admitted during August 2009 and August 2014 were divided into heart failure group（ HF group,n = 71） and cardiorenal syndrome group（ n = 63）,and 60 healthy people at the same period were chosen as control group. The heart function conditions of heart failure patients were observed,and renal function condition were detected in the three groups,and the correlation between serum Klotho protein expression and renal function in heart failure patients were analyzed.Results In cardiorenal syndrome group,the left ventricular end diastolic dimension（ LVDd） value was higher,and left ventricular ejection fraction（ LVEF） value was lower than those in the HF group（ P〈0. 05）,but there was significant difference in New York Heart Association cardiac functional grading in the two groups（ P〈0. 05）. In cardiorenal syndrome group,the values of serum creatinine（ SCr）,urinary micro-albumin（ m Alb）,cystatin-C（ Cys-C）,ɑ_1-microglobulin（ ɑ_1-MG）,β_2-microglobulin（ β_2-MG）,urinary immunoglobulin g（ Ig G）,serum and urinary neutrophilic granulocyte gelatinase associated lipocalin（ NGAL） were significantly higher,while Klotho protein expression was significantly lower than those in the HF and control groups（ P〈0. 05）; the values of m ALB,Cys-C,ɑ_1-MG,β_2-MG,Ig G,serum and urinary NGAL were higher,while Klotho protein expression was lower than those in the control group（ P〈0. 05）.The Klotho protein expression was negatively correlated with Scr,m ALB,Cys-C,ɑ_1-MG,β_2-MG,Ig G,serum and urinary NGAL in HF patients（ P〈0. 05,P〈0. 01）. Conclusion The patients with heart failure complicated with renal injury have a significantly decreased level of serum Klotho protein,which can be used as an important index for evaluating the severity of heart failure in patients.