Relationship Between Serum Level Of Placental Growth Factor With Cardiac Structure And Function In Chronic Kidney Disease Patients

Objective:To investigate the serum level of placental growth factor and explore its relationship with cardiac structure and function in chronic kidney disease patients.Methods:1 We collected seventy-two non-dialysis CKD patients(40 men,32 women) and their mean age was(45.47±12.43) years from the department of nephrology in the Second Hospital of Hebei Medical University. Primary diseases included chronic glomerulonephritis 39 cases, chronic interstitial nephritis 8 cases, hypertensive kidney lesion 4 cases, polycystic kidney diseases 1 case, unknown causes 20 cases. All CKD patients were classified into 3 groups according to glomerular filtration rate(units:ml/min/1.73m2) that computed by CKD-EPI formula: CKD 3 stage(30≤e GFR <60) 24 cases(14men, 10 women),CKD 4 stage(15≤e GFR <30)18 cases(10 men, 8 women) and CKD 5 stage(e GFR <15)30 cases(16 men, 14women). 16 age- and sex- matched healthy controls were collected from the physical examination centre in our hospital. 2 Record the patients’ general situation and blood biochemical indicators such as height, weight, body mass index, age, systolic pressure, diastolic pressure, history of high blood pressure, hemoglobin, serum albumin, high sensitivity C-reactive protein, blood urea nitrogen, serum creatinine, uric acid, total cholesterol, triglycerides, parathyroid hormone, urinary protein of 24 hours. Serum placental growth factor level were measured by ELISA. Cardiac structure and function were assessed by two dimensional echocardiography, including LVDd(left ventricular end diastolic dimension), LAD(left atrial dimension),LVD(left ventricular dimension), LVPW(left ventricular posterior wall), l VS(interventricular septum) and EF(ejection fraction).LVMI(left Ventricular mass index) were measured by Devereux formula{1.04×[(LVST+LVPWT +LVDd)3-LVDd3]-13.6)/BAS. 3 Observe the serum level of placental growth factor and its relationship with different blood biochemical indicators and cardiac associated indicators in CKD patients. Allthese data were undertook statistical analysis and comparison.Results:1 The serum level of PLGF in CKD patients:The serum level of PLGF in CKD patients [3.32(16.80)pg/ml] was significantly higher compared to the healthy controls[2.33(0.22)pg/ml](P<0.05). It progressively increased with the decline of renal function. The serum level of PLGF in CKD 5 stage was significantly higer compared to CKD 4 stage,CKD 3 stage and healthy controls(P<0.05/6). The serum level of PLGF in CKD 4 stage was higher compared to CKD 3 stage and healthy controls(P<0.05/6). The serum level of PLGF in CKD 3 stage was higher than controls(P<0.05/6).2 The heart super living results in CKD patients: The interventricular septum(IVS): The IVS was significantly thicker in CKD patients compared to the healthy controls: CKD 3 stage [10(1)mm],CKD 4 stage [10.5(1)mm],CKD 5 stage [11(2)mm] were thicker than the healthy controls [9(0)mm](P<0.05/6); The left ventricular posterior wall(LVPW):The LVPW was thicker than the healthy controls: CKD 3 stage [10(1)mm],CKD 4 stage [10(1)mm],CKD 5 stage [11(2)mm] were thicker than the healthy controls [9(0)mm](P<0.05/6);The ejection fraction(EF):The EF was significantly lower in CKD patients: CKD 3 stage [(63.55±1.14)%], CKD 4 stage [(63.24±1.14)%],CKD 5 stage [(61.77±1.39)%] were lower than the healthy controls [(64.56±1.27)%]( P<0.05/6). The left ventricular diameter(LVD),the atrial diameter(LAD),left ventricular mass index(LVMI)were higher in patients of CKD 4 stage and CKD 5 stage compared to the healthy controls( P<0.05/6). LVD: {CKD 4 stage[(49.56±3.91)mm],CKD 5 stage [(50.57 ± 4.72)mm] was bigger than the healthy controls[(46.75±2.1)mm]( P< 0.05/6)}.LAD:{CKD 4 stage[(35.94±4.08)mm],CKD 5 stage[(37.97±5.10)mm] was bigger than the healthy control[(31.88±2.19)mm]( P<0.05/6)}. the median PLGF level, while the ejection fraction is opposite.3 PLGF is correlated with cardiac structure and function. It may reflect the cardiac structure and function in CKD patients. LVMI:{CKD 4 stage[(128.44±40.78)g/m2],CKD 5 stage[(153.89±40.46)g/m2] was higher than the healthy controls[(99.64±10.11)g/m2]( P<0.05/6)}.3 The prevalence of left ventricular hypertrophy(LVH) was 53% in CKD patients.It was 25%,50%,77% in CKD 3 stage,CKD 4 stage and CKD 5 stage. The serum PLGF level was higher in patients with left ventricular hypertrophy(LVH) than those without LVH [19.05(17.74)vs 2.99(0.72)pg/ml(P<0.05)]. The sesum level of PLGF in CKD 3 stage,CKD 4 stage and CKD 5 stage were as follows { [( 3.04±0.39)vs(2.68±0.40)pg/ml ],[(3.29±0.15) vs(3.06±0.11) pg/ml ],[(20.64±1.60)vs(19.37±1.68)pg/ml],(P<0.05)}. The prevalence of LVH in the group above median PLGF level was significantly higher than the group below median PLGF level(70% vs 18%, P<0.01). The prevalence of LVMI,LAD,LVD,IVS,LVPW in the patients above the median PLGF level were higher than those in the patients below the median PLGF level. The prevalence of EF was opposite between the two groups.4 PLGF level was positively correlated with LVMI(rs=0.601,P<0.05), systolic pressure(rs=0.476, P<0.05), diastolic pressure(rs=0.236, P<0.05),history of high blood pressure(rs=0.316, P<0.05), 24 h urine protein(rs=0.422, P<0.05), Scr(rs=0.906, P<0.05), UA(rs=0.314, P<0.05),BUN(rs=0.860, P<0.05),i PTH(rs=0.642, P<0.05),and was negatively correlated with LVEF(rs=-0.582, P<0.05),hemoglobin(rs=-0.734, P<0.05),albumin(rs=-0.416, P<0.05),e GFR(rs=-0.889, P<0.05). Multiple regression results showed that UA,Scr, LVEF, hemoglobin were associated with PLGF level independently.The regression equation was Y=109.871+0.014×[Scr]-0.093 ×[Hb]-1.409 ×[EF]-0.016×[UA].Conclusions:1 CKD patients have elevated level of PLGF and it progressively increases with the decline of renal function.2 The serum PLGF level is higher in CKD patients with LVH than those without LVH. The prevalence of left ventricular hypertrophy(LVH) in the group above median PLGF level is significantly higher than the group below...