PDF(Pubmed)
Abstract：
In patients with end-stage renal disease (ESRD), heart failure with reduced ejection fraction (HFrEF) is a common comorbidity. Thromboinflammatory processes in both conditions represent complex pathophysiology, demonstrated by dysregulation of thromboinflammatory biomarkers, and commonly resulting in the combined pathology of cardiorenal syndrome. We sought to investigate the effects of HFrEF on these biomarkers in patients with ESRD, and observe the relationship to mortality. Blood samples from 73 patients with ESRD (mean age 67 ± 13 years, 56% male) and 40 healthy controls were analyzed via enzyme-linked immunosorbent assay and other chromogenic methods for angiopoietin-2 (Ang2), endogenous glycosaminoglycans, fatty acid binding protein, interleukin-6, lipopolysaccharide, free fatty acids, NT-pro B-type natriuretic peptide, tumor necrosis factor α, vascular endothelial growth factor, and von Willebrand factor. Patients were stratified into those with or without HFrEF (EF < 50%). Patients had highly prevalent comorbidities including coronary artery disease 46%, diabetes 69%, hypertension 97%, and smoking 49%. Most biomarkers were upregulated in ESRD compared to controls. Patients with HFrEF and ESRD had greater interleukin-6 and NT-pro B-type natriuretic peptide and lesser lipopolysaccharide compared to ESRD only. Spearman correlations between most biomarkers were increased in HFrEF + ESRD over ESRD only. Ang-2 was associated with mortality in this cohort. The dysregulation of thromboinflammation in ESRD is somewhat amplified in comorbid HFrEF. Correlation among biomarkers in this cohort indicates the mechanisms of thromboinflammatory biomarker generation in ESRD and HFrEF share an integrative process. Ang2, interleukin-6, and lipopolysaccharide show promise as biomarkers for risk stratification among patients with both HFrEF and ESRD.
摘要：
在终末期肾病（ESRD）患者中，射血分数降低的心力衰竭(HFrEF)是一种常见的合并症.这两种情况下的血栓炎症过程代表了复杂的病理生理学，通过血栓炎症生物标志物的失调来证明，通常导致心肾综合征的综合病理。我们试图研究HFrEF对ESRD患者这些生物标志物的影响，观察与死亡率的关系。来自73例ESRD患者的血液样本（平均年龄67±13岁，56％男性）和40名健康对照通过酶联免疫吸附测定和其他显色方法分析血管生成素2（Ang2），内源性糖胺聚糖，脂肪酸结合蛋白，白细胞介素-6，脂多糖，游离脂肪酸,NT-proB型利钠肽,肿瘤坏死因子α,血管内皮生长因子，和vonWillebrand因子.将患者分为有或没有HFrEF的患者（EF<50％）。46％的患者有高度普遍的合并症，包括冠状动脉疾病，糖尿病69%,高血压97%,吸烟49%。与对照相比,大多数生物标志物在ESRD中上调。与仅ESRD相比，HFrEF和ESRD患者的白介素6和NT-proB型利钠肽更高，脂多糖更低。大多数生物标志物之间的Spearman相关性在HFrEF+ESRD中比仅在ESRD中增加。Ang-2与该队列中的死亡率相关。ESRD中血栓炎症的失调在合并症HFrEF中有所放大。该队列中生物标志物之间的相关性表明ESRD和HFrEF中血栓炎症生物标志物产生的机制共享一个整合过程。Ang2、白介素-6和脂多糖有望作为HFrEF和ESRD患者风险分层的生物标志物。
