The Serum Levels Of PIVKA-â…¡and Sialic Acid In Patients With Chronic Renal Insufficiency

Objective To investigate the effects of renal insufficiency on serum levels of protein induced by vitamin K absence or antagonist-â…¡(PIVKA-â…¡) and sialic acid(SA).Methods The levels of serum PIVKA-â…¡, SA, urea and creatinine( Cr) from 127 chronic kidney disease( CKD) patients with renal insufficiency, 32 ones with normal renal function, 57 healthy controls and 120 patients with hepatocellular carcinoma( HCC) were determined by chemiluminescent, enzymatic, urease and picric acid methods respectively. The gender, age, weight and serum Cr levels of the patients with CKD were recorded to calculate the estimated glomerular filtration rate( e GFR) using the Chinese GFR formula. All data were processed with SPSS 20.0 software( SPSS, Chicago, IL, USA). The serum levels of PIVKA-â…¡ and SA were expressed with median( M), Twenty-fifth percentile( P25) and Seventy-fifth percentile( P75) because of their data skewness distribution. Non parametric Kruskal- Wallis H test was used to compare the data among all the groups, and the Mann-Whitney U test was done for two groups. The correlation between serum PIVKA-â…¡, SA and e GFR, Urea, Cr levels were analyzed by linear correlation analysis respectively.Results(1) There was no significant difference in the serum PIVKA-â…¡ levels among healthy controls, the CKD patients with normal renal function and the CKD patients with renal insufficiency( H=2.902, P > 0.05). The PIVKA-â…¡ levels were significantly lower in above three groups than in the HCC one( U=319.5, 203, 665.5 respectively, P < 0.001). Serum PIVKA-â…¡ levels among the CKD2,3,4,5 groups had no statistical change( H = 3.991,P > 0.05). However, serum SA levels had statistical difference among healthy controls, the CKD patients with normal renal function and the CKD patients with renal insufficiency( H = 63.685, P < 0.001), and among the CKD2,3,4,5 groups( H = 64.689, P < 0.001). The serum SA levels in the patients with renal insufficiency were significantly higher than those in the patients with normal renal function and the healthy controls( U=769.50, 1278.50 respectively, P < 0.001). The serum SA levels in CKD4 were significantly higher than those in CKD2,3( U = 172.00 and 265.00 respectively, P < 0.001), lower than CKD5( U =240.50, P < 0.001); The serum SA levels in CKD3 were significantly higher than those in CKD1( U = 298.50, P < 0.001) and the healthy control group( U = 492.00, P < 0.001); The serum SA levels in CKD2 were significantly higher than the healthy control group( U = 584.50, P < 0.001). But there were no significantdifference between CKD2 and CKD3( U = 436.00, P < 0.001), between CKD2 and the healthy control group( U = 365.50, P < 0.001), neither between the healthy control group and CKD1( U = 834.50, P < 0.001).(2) There were negative correlations between serum SA and e GFR levels( r=-0.705,P < 0.001), and positive correlations between serum SA and BUN levels( r = 0.599,P < 0.001), and serum SA and Cr levels( r = 0.704,P < 0.001). The SA levels had a significant increase in the HCC group compared to those in CKD1~4( U = 126.00,163.50, 247.00, 715.00 respectively, P < 0.001), but no change with CKD5(U=419.00, P > 0.05).Conclusions The renal insufficiency significantly increase serum SA, but not PIVKA-â…¡levels,which is much depends on the extent of renal insufficiency. These results suggested clinicians not only to suspect the patient suffering from a malignant tumor, but also pay attention to the the effect of renal insufficiency when facing the increased SA levels.