Study on relationship between serum growth stimulation expressed gene 2 and lipoprotein-associated phospholipase 2 and cardiovascular events in maintenance hemodialysis patients

doi:10.16138/j.1673-6087.2022.04.005

Abstract

Abstract:

Objactive To explore the association between suppression of growth stimulation expressed gene 2 (ST2), lipoprotein-associated phospholipase A2(LP-PLA2) and cardiovascular events in the patients with maintenance hemodialysis (MHD). Methods A total of 117 MHD patients at our hospital from January 2016 to January 2017 were selected. The serum ST2 and LP-PLA2 levels were measured before hemodialysis. The patients were followed up, and the primary endpoint was occurrence of cardiovascular events. The receiver-operating characteristic curve was analyzed to determine if ST2 and LP-PLA2 were associated with cardiovascular events in MHD patients. The univariate and multivariate Cox regression analysis was used to determine the risk factors of cardiovascular events in the MHD patients. Results The ST2 and LP-PLA2 levels were significantly higher in the patients with cardiovascular events than those without events (all P<0.05). The areas under the curve of ST2 and LP-PLA2 distinguishing the MHD patients with or without cardiovascular events were 0.77 and 0.70, respectively; and it increased to 0.83 when the 2 biomarkers were used in combination. The Kaplan-Meier curve analysis showed that the MHD patients with ST2≤61 μg/L had a significantly longer time free from cardiovascular events than those with ST2>61 μg/L(53 months vs 28 months, P<0.001). Similarly, the MHD patients with LP-PLA2≤266 μg/L had a significantly longer time free from cardiovascular events than those with LP-PLA2>266 μg/L (50 months vs 37 months, P=0.001). The multivariate Cox regression analysis presented the brain natriuretic peptide (BNP) [ hazard ratio(HR)=1.01, P<0.001], ST2>61 μg/L (HR=1.27, P<0.001) and LP-PLA2>266 μg/L (HR=1.92, P<0.001) was independent risk factor for cardiovascular events in the MHD patients. Conclusions The serum ST2 and LP-PLA2 are independent risk factors for cardiovascular events in the MHD patients, and measurement of ST2 and LP-PLA2 may help to evaluate risk stratification.

Key words: Growth stimulation expressed gene 2, Lipoprotein-associated phospholipase A2, Maintenance hemodialysis, Cardiovascular events

CLC Number:

R459.5
R54

GAO Jian, WANG Deqin, ZHOU Yonghua, MIAO Xianjing, CHEN Yu, JING Xin, WANG Yan. Study on relationship between serum growth stimulation expressed gene 2 and lipoprotein-associated phospholipase 2 and cardiovascular events in maintenance hemodialysis patients[J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(04): 295-300.

Figures/Tables 5

References 19

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项目	有心血管事件组（n=66）	无心血管事件组（n=111）	t/χ²	P
年龄（岁）	69.55±7.32	61.24±5.84	8.30	<0.001
性别（男）[n（%）]	38（57.58）	62（55.86）	0.05	0.82
原发病[n（%）]			0.27	0.97
肾小球肾炎	6（9.1）	9（8.1）
糖尿病肾病	21（31.8）	39（35.1）
其他	11（16.7）	19（17.1）
不明	28（42.4）	44（39.6）
透析龄（月）	50.74±7.68	39.43±8.91	8.58	<0.001
MAP（mmHg）	101.85±13.45	103.16±16.02	-0.59	0.56
TC（mmol/L）	5.12±0.75	4.63±0.71	4.35	<0.001
LDL（mmol/L）	2.79±0.71	2.51±0.48	2.87	0.005
HDL（mmol/L）	0.94±0.25	1.10±0.30	-3.73	<0.001
TG（mmol/L）	1.99±0.25	1.89±0.29	2.28	0.03
Ca（mmol/L）	2.33±0.22	2.20±0.22	3.70	<0.001
P（mmol/L）	1.88±0.40	1.77±0.31	1.90	0.06
UA（mmol/L）	442.95±19.92	406.04±25.65	10.69	<0.001
Alb（g/L）	34.60±2.12	37.93±2.51	-9.03	<0.001
BNP（ng/L）	745.71±35.21	355.63±61.23	47.28	<0.001
Hb（g/L）	103.26±10.76	119.12±7.53	-10.54	<0.001
LVEF（%）	48.56±7.28	54.73±6.69	-5.74	<0.001
LVDD（mm）	47.24±5.83	48.05±6.24	-0.85	0.40
ST2（μg/L）	68.47±19.32	50.53±16.37	6.59	<0.001
LP-PLA2（μg/L）	269.27±46.30	234.38±39.19	5.35	<0.001

指标	截断值	AUC（95% CI）	灵敏度（%）（95%CI）	特异度（%）（95%CI）	P
ST2（μg/L）	61	0.77（0.71~0.83）	74.2（60.2~84.2）	77.5（68.6~84.9）	<0.001
LP-PLA2（μg/L）	266	0.70（0.63~0.77）	48.5（36.0~61.1）	82.0（73.6~88.6）	<0.001
ST2+LP-PLA2	/	0.83（0.77~0.89）	74.2（60.2~84.2）	82.0（73.6~88.6）	<0.001

变量	单因素分析		多因素分析
变量	HR（95% CI）	P	HR（95% CI）	P
年龄（≥60岁）	6.67（2.42~18.36）	<0.001	1.22（0.37~3.99）	0.75
性别（男性）	1.20（0.73~1.95）	0.48
原发病
肾小球肾炎		1
糖尿病肾病	1.25（0.51~3.03）	0.62
其他	1.07（0.61~1.89）	0.82
不明	1.05（0.52~2.12）	0.89
透析龄	1.07（1.05~1.09）	<0.001	1.00（0.97~1.04）	0.98
MAP	1.00（0.98~1.02）	0.97
TC	1.93（1.40~2.66）	<0.001	1.12（0.77~1.63）	0.55
LDL	1.58（1.09~2.28）	0.02	1.18（0.78~1.78）	0.44
HDL	0.14（0.06~0.34）	<0.001	0.29（0.08~1.04）	0.06
TG	1.93（0.78~4.79）	0.16
Ca	3.88（1.36~11.07）	0.01	1.21（0.05~1.82）	0.48
P	2.48（1.17~5.29）	0.02	1.45（0.21~1.98）	0.05
UA	1.04（1.03~1.05）	<0.001	1.00（0.99~1.02）	0.89
Alb	0.74（0.67~0.81）	<0.001	0.99（0.86~1.13）	0.86
BNP	1.01（1.00~1.02）	<0.001	1.01（1.00~1.02）	<0.001
Hb	0.93（0.91~0.94）	<0.001	1.01（0.98~1.04）	0.55
LVEF	0.93（0.90~0.96）	<0.001	1.02（0.99~1.07）	0.20
LVDD	0.99（0.95~1.03）	0.55
ST2（>61 μg/L）	11.28（6.38~19.95）	<0.001	1.27（1.13~1.57）	<0.001
LP-PLA2（>266 μg/L）	2.18（1.34~3.55）	0.002	1.92（1.49~2.73）	<0.001