循环半乳糖凝集素3水平预测慢性肾脏病患者心血管事件风险的价值

Relationship of galectin-3 and risk of cardiovascular events in chronic kidney disease patients

目的：分析循环半乳糖凝集素3（Gal-3）水平在预测慢性肾脏病（CKD）患者心血管事件风险中的价值。方法：将2013年12月~2015年3月住院的CKD 2~5期患者纳入观察,另纳入70例年龄、性别匹配的健康体检者为对照组。分析患者临床表现,入院24h后完善相关实验室检查,双抗体夹心法检测血清Gal-3浓度。心脏超声测定左心室舒张末期内径（LVEDD）、左心室后壁厚度（PWTd）、室间隔厚度（SWTd）,计算相对室壁厚度（RWT）和左心室质量（LVM）、左心室质量指数（LVMI）,描述瓣膜钙化情况。冠脉CT检查行冠脉钙化评分（CAC）、腹部侧位平片检查行腹主动脉钙化评分（AAC）。分析循环Gal-3水平与心血管危险因素、心血管塑形及钙化的关系。结果：共纳入436例CKD患者,CKD 2期患者Gal-3水平显著高于对照组（P〈0.001）;随肾功能减退,该升高趋势愈加显著（P均〈0.001）。Gal-3水平与CKD患者多项心血管危险因素有相关性（P〈0.05）;与心超测量参数LVEDD/BSA、PWTd、LVM和LVMI均相关（P〈0.05）。血清Gal-3水平与心血管钙化无相关性。结论：Gal-3水平在CKD早期即显著升高,升高的Gal-3水平不仅与患者多项心血管事件危险因素相关,亦与左心室重塑相关。将Gal-3纳入CKD患者心血管事件风险的评价体系中可能具有特殊价值。

Objective： To investigate the relationship between serum galectin-3（ Gal-3） levels and the risk of cardiovascular events and left ventricular geometry remodeling in chronic kidney disease（ CKD） patients. Methodology：From Dec. 2013 to Mar. 2015,the patients aged 16 ~ 65 years with baseline CKD stages 2 to 5 were investigated,and a total of 436 CKD patients were enrolled in the final analysis. They were male 272 and female 164 with an average age of42. 3 ± 15. 8 years old. Baseline clinical characteristics were obtained. Serum uric acid,creatinine,albumin and Creactive protein were measured by standard laboratory techniques. Glomerular filtration rate（ GFR） was calculated using the CKD-EPI formula. Serum Gal-3 levels were measured by using enzyme linked immunosorbent assay（ ELISA）. Nterminal pro-hormone of brain natriuretic peptide（ NT-pro BNP）（ Normal values 0 ~ 53. 1 pmol / L） and cardiac troponin T（ c Tn T） was measured by an electrochemiluminescence immunoassay（ ECLIA）. All patients were examined by transthoracic echocardiography to measure the diameter of the left ventricle. Left ventriclar mass index（ LVMI） and relative wall thickness（ RWT） were obtained by chocardiography. Coronary artery calcification score（ CACS） was determined by Spiral computed tomographe coronary angiography. Lateral luvbar X-ray score of the abdominal aorta was used to determine aortic artery calcification（ AAC）. Results： Serum Gal-3 concentrations were significantly highly in CKD stage 2 patients than that of control group [22. 47（ 16. 18,29. 40） ng / ml vs 16. 69（ 13. 94,19. 75） ng / ml]. Serum Gal-3 concentrations were strongly correlated with e GFR. Other variables with moderate to strong correlations with serum Gal-3 concentration in participants were smoking,diabetes,blood pressure,levels of hemoglobin,albumin,total cholesterol,Cys C,P,PTH,NT-pro BNP,Tn T and 24 h proteinuria. Serum Gal-3 were correlated moderately with LVEDD / BSA、PWTd、LVM and LVMI. There was no evidence of higher serum levels of Gal-3 associated with an increased risk of incident coronary artery or abdominal aorta or cardiac valve calcification. Conclusion： Serum Gal-3 concentrations were significantly highly in CKD early stage. Higher serum levels of Gal-3 were associated with several cardiovascular risk factors and left ventricular geometry remodeling in CKD patients. Serum Gal-3 can serve as potential candidates for prediction risk of cardiovascular events in CKD patients.