血浆皮质醇、肾素水平与老年慢性肾脏病3~5期患者主要不良心血管事件发生的关系

Relationships between cortisol,renin levels in plasma and major adverse cardiovascular events in elderly patients with stage 3-5 chronic kidney disease

目的分析血浆皮质醇(COR)、肾素(REN)水平与老年慢性肾脏病(CKD)3~5期患者主要不良心血管事件(MACE)的关系。方法回顾性分析2014年10月至2017年11月在东南大学附属中大医院江北院区确诊的老年CKD 3~5期且未行肾脏替代治疗的215例患者临床资料,采用化学发光法检测血浆去甲肾上腺素(NE)、REN和COR水平,采用免疫比浊法检测血浆C反应蛋白(CRP)水平,根据患者随访过程中是否发生MACE将患者分为MACE组和非MACE组,比较两组血浆NE、REN、CRP和COR水平,采用Logistic回归分析老年CKD 3~5期患者发生MACE的危险因素,采用受试者工作特征(ROC)曲线分析COR、REN对CKD患者发生MACE的预测价值。结果与非MACE组比较,MACE组24 h蛋白尿水平及血浆NE、REN、CRP、COR水平明显升高,差异均有统计学意义(P<0.05);Logistic回归分析显示,肾功能分期高,以及血浆REN、COR和CRP水平升高均是老年CKD 3~5期患者发生MACE的独立危险因素;ROC曲线分析显示血浆REN、COR预测老年CKD 3~5期患者发生MACE的曲线下面积(AUC)分别为0.780和0.885,二者联合检测预测MACE发生的AUC为0.932。结论血浆COR、REN水平升高是老年CKD 3~5期患者发生MACE的独立危险因素,二者对老年CKD 3~5期患者发生MACE具有一定预测价值。

Objective To evaluate the relationships between levels of cortisol(COR),renin(REN)in plasma and major adverse cardiovascular events(MACE)in elderly patients with stage 3-5 chronic kidney disease(CKD).Methods A total of 215 elderly patients with stage 3-5 CKD who were diagnosed in Jiangbei Branch of Zhongda Hospital Affiliated to Southeast University from October 2014 to November 2017 were analyzed retrospectively,patients′clinical data were collected,and chemiluminescence method was used to measure plasma norepinephrine hormone(NE),REN and COR levels,and immunoturbidimetry method was used to measure plasma C-reactive protein(CRP)level,patients were divided into MACE group and non-MACE group according to the occurrence of MACE during follow-up,the levels of NE,REN,CRP and COR were compared between the two groups,Logistic regression analysis was used to analyze the risk factors of MACE in stage 3-5 CKD patients,and ROC curve was used to analyze the predictive value of COR and REN for MACE in CKD patients.Results Compared with those in non-MACE group,the levels of 24 h proteinuria,plasma NE,REN,CRP and COR in MACE group significantly increased(P<0.05).Logistic regression analysis showed that high renal function staging,and high plasma levels of REN,COR and CRP were independent risk factors for MACE in elderly patients with stage 3-5 CKD.ROC curve analysis showed that the areas under the ROC curve(AUC)of REN and COR in predicting MACE in elderly patients with stage 3-5 CKD were 0.780 and 0.885 respectively,the AUC of combined detection of plasma REN and COR levels to predict MACE in elderly patients with stage 3-5 CKD was 0.932.Conclusion High levels of COR and REN are independent risk factors for MACE in elderly patients with CKD,and both of them have a certain predictive value for the occurrence of MACE in elderly patients with stage 3-5 CKD.