慢性肾脏病患者血清NGAL、OPN及MMP9水平与左心室肥厚的关系

Relationship between the Serum Levels of Neutrophil Gelatinase-associated Lipocalin(NGAL),Osteopontin(OPN)and Matrix Metalloproteinase 9(MMP9)with Left Ventricular Hypertrophy in Patients with Chronic Kindey Disease

目的探讨血清中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase associated lipocalin,NGAL)、骨桥蛋白(osteopontin,OPN)及基质金属蛋白酶9(matrix metalloproteinase 9,MMP9)水平与慢性肾脏病(chronic kidney disease,CKD)3~5期患者发生左心室肥厚(left ventricular hypertrophy,LVH)的相关性。方法纳入CKD患者144例,根据患者估算肾小球滤过率(eGFR)分为A组(CKD3期,n=60)、B组(CKD4期,n=48)、C组(CKD5期,n=36),另选取同期30例健康体检者作为对照组,比较不同分期CKD患者临床资料及血清标志物水平的差异。采用二分类Logistic回归分析CKD患者发生LVH的危险因素,绘制ROC曲线评价NGAL、OPN、MMP9及联合检测对CKD患者发生LVH及LVDD的诊断价值。结果CKD患者血清NGAL、OPN及MMP9水平显著高于对照组,差异均有统计学意义(P均<0.05),且LVH组患者的血清NGAL、OPN及MMP9水平明显高于非LVH组,差异均有统计学意义(P均<0.05)。Logistic回归分析显示,年龄、收缩压、CRP、NGAL、OPN、MMP9是CKD3~5期患者发生LVH的独立危险因素;ROC曲线分析显示,血清NGAL、OPN及MMP9水平联合预测CKD3~5期患者发生LVH的AUC为0.890,敏感度、特异性分别为87.36%、79.91%。结论血清高水平NGAL、OPN及MMP9与CKD3~5期患者发生LVH密切相关。

Objective To investigate the relationship between the serum levels of neutrophil gelatinase-associated lipocalin(NGAL),osteopontin(OPN)and matrix metalloproteinase 9(MMP9)with left ventricular hypertrophy in patients with chronic kindey disease.Methods This study enrolled 144 CKD non-dialysis patients.According to the level of eGFR,the patients was subdivided into three groups of A group(stageⅢ,60 cases),B group(stageⅣ,48 cases)and C group(stageⅤ,36 cases),thirty individuals with healthy physical examination were enrolled as the control group.The difference of serum biomarkers levels and general data in patients with different stages of CKD were compared.Risk factors for LVH were analyzed by binary Logistic regression.ROC curve was used to evaluate the diagnostic value of the every index and a combined detection for LVH in CKD patients.Results The serum levels of OPN,NGAL and MMP9 were significantly higher in the CKD group than in the healthy control group(P<0.05),as well as in the LVH group than in the non-LVH group(P<0.05).Binary Logistic regression analysis showed that age,systolic pressure,C-reactive protein,NGAL,OPN and MMP9 were the independent risk for LVH in CKD patients.Receiver operating characterisitc curve showed that the AUC for predicting LVH and LVDD uising OPN、NGAL and MMP9 was 0.890,the sensitivities was 87.36%,and the specificities was 79.91%.Conclusion Higher serum NGAL,OPN and MMP9 levels were closely related to LVH in CKD patients with stage 3-5 non-dialysis.