| مستخلص: |
Objective To investigate the relationship of soluble CD146 (sCD146) with atherosclerosis and future cardiovascular events in patients with diabetic kidney disease (DKD). Methods A total of 105 DKD patients at chronic kidney disease(CKD) (68 male, 37 female) stage 1-3 were enrolled and another 94 type 2 diabetes mellitus patients without DKD (64 male, 30 female) entered the control group from January 2013 to December 2015 in our hospital. Plasma concentration of sCD146 was measured. Doppler ultrasounds of carotid and lower extremity artery were performed. All the DKD patients were retrospectively followed up (medium follow-up 28 months) .The differences of sCD146 between DKD patients and control group was analyzed and the relationship between sCD146 and proteinuria and renal function was evaluated in DKD patients. The association between sCD146 and atherosclerosis was explored in DKD patients. Kaplan-Meier method was used to evaluate the predictive value of sCD146 in future cardiovascular events. Results The level of sCD146 in diabetes mellitus patients was lower than that of DKD group [the level of sCD146 was (435± 150) and (602 ± 274) µg/L, respectively, t=-5.246, P<0.001]. Spearman analysis showed the positive association between sCD146 and serum creatinine (r=0.36, P<0.001), urinary albumino-to-creatinine ratio (r= 0.225, P=0.001) and its negative correlation with eGFR (r=-0.376, P<0.001). The elevation of sCD146 was further associated with the progression of CKD [the levels of sCD146 in patients of CKD stage 1, 2 and 3 were (472 ± 172), (590 ± 223), (685 ± 340) µg/L, respectively, F=164.203, P<0.001]. In DKD group, the upregulation of sCD146 was associated with both the increase of carotid intima-media thickness (r=0.577, P< 0.001) and femoral intima-media thickness (r=0.765, P<0.001). Patients with higher level of sCD146 tended to have more carotid plaques [OR(95%CI)=17.302(2.752-108.780), P=0.002], unstable carotid plaques [OR (95%CI)=6.404(1.036-39.608), P=0.046] and unstable plaques in lower extremity arteries [OR(95%CI)= 13.641(1.942- 95.825), P=0.009] after the adjustment of other cardiovascular risks. Patients with higher concentration of sCD146 tended to have poorer cardiovascular outcomes (Log rank χ²=9.366, P=0.049). Conclusions The measurement of plasma sCD146 is a noninvasive way which can sensitively reflect the progression of renal function and atherosclerosis, and it can also be a good marker to predict cardiovascular outcomes in DKD patients at CKD stage 1-3. [ABSTRACT FROM AUTHOR] |