The Effect Of Myocardial Enzyme To The Early Stage Of Chronic Kidney Disease

Objective To investigate the effect of the Creatine Kinase (CK), Creatine Kinase-MB (CK-MB), Lactate Dehydrogenase (LDH), Alpha-hydroxybutyric dehydrogenase (a-HBDH) and Aspartate Aminotransferase (AST) on early stage of chronic kidney disease (CKD), and analyzed the impact of abnormal serum CK level on the CKD1patients.Methods All CKD1-2patients who were admitted to the Department of Nephropathy in Lanzhou University Second Hospital from Feb.1,2011to Feb.1,2012were included, and we retrospectively analyzed all data of them and the differences between the CK abnormal group and normal group.Results1.General condition:the number of CKD1-2patients was481, the CKD1patients were354(73.6%),192male and162female, the mean age was (34.07+16.68) year; the CKD2patients were127(26.4%),67male and60female, the mean age was (45.59±17.88) year.2.The correlation analysis showed that CK, CKMB and aHBDH were negatively correlated with eGFR in early stage of CKD (P<0.05), only CK was negatively related to eGFR excluding the factor of infection (P<0.05).3.There were statistically differences between CKD1and CKD2patients in CKMB, LDH and aHBDH (P<0.05) regardless of the presence of infection or not.4.The level of CKMB, LDH and aHBDH were increased in early stage of CKD along with the increasing of the level of serum creatinine, uric acid, total cholesterol and triglyceride (P<0.05), the proportion of infection, lupus nephritis (LN) were higher than the normal group (P<0.05); the level of uric acid, IgA were increased, the proportion of abnormal cardiovascular and LN were higher in the increased group excluding the factor of infection (P<0.05).5.In the CK increased group of CKD1-2, the level of cystatin C, C react protein (CRP),24-hour urinary total protein (UTP) excretion and N-acetyl-β-D-glucosaminidase (NAG) were increased (P<0.05), the percentage of anemia and metabolic bone disease (MBD) were higher (P<0.05); after excluding infection, the level of triglyceride was increased (P<0.05), the MBD proportion had no statistically significantly differences between the abnormal and normal group except above results.6.(1) In the CKMB increased group of CKD1-2, the level of uric acid, cystatin C, total cholesterol, triglyceride, low density lipoprotein (LDL) and UTP were increased (P<0.05), the level of IgG was declined (P<0.05), the percentage of MBD, infection and nephrotic syndrome (NS) were higher (P<0.05); after excluding infection, the results of uric acid, cystatin C, total cholesterol, triglyceride, LDL and UTP were unaltered, the level of urine erythrocyte was reduced (P<0.05), the LN rate was higher (P<0.05);(2) The patients were younger in the CKMB increased group of CKD1(P<0.05), the level of uric acid, total cholesterol and NAG were elevated (P<0.05), the IgG level was declined (P<0.05), the MBD percentage was higher (P<0.05); after excluding infection, the results of age, total cholesterol, MBD were same, the level of urine erythrocyte was reduced (P<0.05);(3) In the CKMB increased group of CKD2, the level of total cholesterol, triglyceride, LDL, urine PH and UTP were elevated (P<0.05), the NS and LN percentage were higher (P<0.05); after excluding infection, the results of total cholesterol, triglyceride, LDL and LN were changeless.7.(1) In the LDH, aHBDH both increased group of CKD1-2, the level of uric acid, cystatin C, total cholesterol, triglyceride, high density lipoprotein (HDL), CRP, UTP and NAG were increased (P<0.05), the percentage of abnormal cardiovascular, anemia, MBD, infection and LN were higher (P<0.05); after excluding infection, the results of cystatin C, triglyceride, CRP, NAG, cardiovascular events, anemia, MBD and LN were same (P<0.05);(2) In the LDH, aHBDH both increased group of CKD1, the level of cystatin C, triglyceride and CRP were elevated (P<0.05); after excluding infection, the patients in abnormal group were older (P<0.05), the level of UTP and NAG were increased except above results (P<0.05);(3) The level of CRP and urine PH were increased (P<0.05), the infection rate was higher in CKD2abnormal group (P<0.05); after excluding infection, the result of CRP was unaltered.8.(1) In the CK, LDH and aHBDH increased group of CKD1-2, the level of cystatin C, triglyceride and CRP were elevated (P<0.05), the level of HDL was declined (P<0.05), the percentage of anemia and LN were higher (P<0.05); the results were invariable after excluding infection;(2) the level of uric acid, cystatin C, triglyceride and CRP were increased (P<0.05), the level of HDL was declined (P<0.05), the proportion of anemia and LN were higher in CKD1abnormal group (P<0.05); the results were same after excluding infection;(3) There was no statistically significantly differences between the abnormal and normal group in CKD2(P>0.05).9.In the CK increased group of CKD1, the level of cystatin C, triglyceride, CRP and UTP were increased (P<0.05), the level of NAG was declined (P<0.05), the percentage of anemia and MBD were higher (P<0.05); after excluding infection, the level of NAG was increased (P<0.05), and the proportion of LN patients was high except above results (P<0.05); after excluding abnormal cardiovascular, the level of cystatin C, NAG were increased (P<0.05), the percentage of anemia and MBD were higher (P<0.05); after excluding abnormal cardiovascular and infection, the level of cystatin C, triglyceride, NAG were increased (P<0.05), the percentage of anemia was higher (P<0.05).lO.The correlation analysis showed that CK was negatively correlated with eGFR in CKD1(P<0.05), as well as excluding the factor of infection or abnormal cardiovascular (P<0.05), but there was no statistically significantly differences between CK and eGFR after excluding the factor of infection and abnormal cardiovascular (P>0.05).11.Follow-up:(1) The mean follow-up time of CKD1patients was (28.09±3.79) months, and206patients were followed;(2) Creatinine multiplication:①The numbers of creatinine multiplication in CK abnormal group was1person(12.5%),5people(2.5%) in normal group, there was no statistically significantly differences between them (P>0.05);②The percentage of creatinine multiplication was12.5%in CK abnormal group, and the CK normal group was2.5%, there was no statistically significantly differences between them(P>0.05);(3) Death:①The numbers of death in CK abnormal group was1person(12.5%),2people(1%) in normal group, there was no statistically significantly differences between them (P>0.05);②The24-month survival rate of CK abnormal group was87.5%, and the CK normal group was99%, which had statistically significantly differences.Conclusion1. As the CKD1-2patients with increasing the level of CK, LDH and aHBDH, the level of uric acid was elevated concurrently with infection.2. CK was negatively related to eGFR in early stage of CKD, the renal lesion of these patients was more serious, especially the impairment of tubular, the percentage of anemia and MBD were also higher.3. The level of cholesterol was elevated when CKMB was abnormal in CKD1-2, but it was not correlated with the renal lesion.4. The level of CRP was elevated, the rates of cardiovascular events, anemia, MBD were also increased in LDH and aHBDH both increased patients of CKD1.5. The level of cystatin C was elevated and the proportion of anemia and LN were also higher in CKD1patients with increasing of the level of CK, LDH and aHBDH all increased.6.There was no correlation between the increased level of CK and CKD progression in CKD1, but there was correlation between the increased level of CK and mortality rate, and the patients of abnormal level of CK had high mortality rate.