| Objective:Chronic renal dysfunction and coronary heart disease are common diseases in the elderly and are the major diseases that affect the health and longevity of the elderly.The incidence of cardiovascular disease in patients with chronic kidney disease is high,can occur in the early stages of kidney disease.With the progress of kidney disease,the incidence of cardiovascular diseases is getting higher and higher.The change of left ventricular structure and function is one of the most prominent features of heart damage in chronic kidney disease patients.Numerous studies have shown that abnormal renal function and cardiac structure abnormalities are independent risk factors for heart failure,arrhythmia and sudden cardiac death.Since the two are so closely linked to cardiovascular events,any possible method of predicting or improving renal and cardiac function may also reduce the risk of cardiovascular events and death.Cardiac dysfunction mainly manifests as enlargement of the left ventricle and atrium,and the assessment of renal dysfunction is usually glomerular filtration rate,but its value in the assessment of cardiovascular disease risk in patients with chronic kidney disease is of limited value.Serum sulfatide,a very sensitive indicator of atherosclerosis and changes in renal function,may be important in monitoring the occurrence and progression of cardiac and renal insufficiency.Sulfatide is an acidic sphingoglycolipid widely found in the nervous system,kidney,liver,spleen,stomach,small intestine and serum,were first isolated from human brain tissue by Thudichum in 1884.As a lipid that is normally present in large quantities in the body,sulfatide has important physiological functions in the tissues and organs in which it is present.Not only is sulfatide a component of cell membranes,but also involved in protein transport,cell adhesion and aggregation,axonal-myelin interactions,regulation of sodium-potassium channels,learning,memory,and neuroplasticity.In recent years,studies have found that sulfatide also plays a non-negligible biological role in cardiovascular diseases and renal insufficiency.This study aimed to investigate the relationship between serum sulfatide and glomerular filtration rate in patients with coronary heart disease and left ventricular structural and functional changes in order to further understand the inherent relationship between renal dysfunction and cardiovascular events such as arrhythmia and heart failure.At the same time for the prevention and treatment of coronary heart disease to provide a new idea.Methods:Sixty hospitalized patients diagnosed with coronary heart disease were enrolled in this research.All of them were assigned to 3 groups according to the tertiles of the estimated glomerular filtration rate?eGFR?:A group contain19 patients(eGFR<57.28mlˇmin-1ˇ1.73 m-2),B group contain 21 patients(57.28?eGFR<74.86mlˇmin-1ˇ1.73 m-2),C group contain 20 patients(eGFR?74.86 mlˇmin-1ˇ1.73 m-2).Venous blood was collected early in the morning and sent to the laboratory for detection of serum creatinine.eGFR was calculated according to the simplified MDRD formula,eGFR=186×serum creatinine-1.154×age-0.203×1.233×?0.742 women?.Another 3 ml of venous blood was collected and the serum was separated.Matrix-assisted laser desorption ionization time-of-flight mass spectrometry?MALDI-TOF MS?was used to detect the level of serum sulfatide.Left ventricular structure and function were measured by echocardiography.The levels of sulfatide,left atrial diameter,left ventricular diameter,interventricular septum thickness,left ventricular posterior wall thickness,left ventricular mass,left ventricular mass index,E peak,A peak and left ventricular ejection fraction were compared between different renal function patients.Then,the correlation between serum sulfatide concentration,eGFR and left ventride structure and function were analyzed.Results:1 With the decline of eGFR,serum sulfatide levels gradually decre-ase?A<B<C,P<0.05?,and serum creatinine levels gradually increa-sed?A>B>C,P<0.05?.When the eGFR is significantly decreased,the left atrial diameter increases?A>C,P<0.05?,the ejection fraction decreases?A<B,P<0.05?,and the left ventricular end-systolic diam-eter increases?A>C,P<0.05?.2 Serum sulfatide concentration was negatively related to left atrial diameter?r=-0.635,P<0.05?,or E peak?r=-0.577,P<0.05?,but was significantly positively related to eGFR?r=0.817,P<0.01?.3 eGFR was significantly negatively correlated with left atrial dia-meter and E peak?r=-0.716,P<0.05;r=-0.699,P<0.05,respetively?.A-fter multivariable adjustments,serum sulfatide is still significantly corr-elated with eGFR?P<0.05?,and eGFR is significantly negatively correl-ated with E peak?P<0.05?.Conclusions:1 Serum sulfatide levels are significantly elevated in elderly patients with coronary heart disease,confirming the hypothesis that serum sulfatide is a novel marker of coronary heart disease.2 Serum sulfatide levels were positively correlated with estimated glomerular filtration rate,and as the renal function deteriorated,the level of serum sulfatide gradually decreased,suggesting that we may be able to delay the progression of renal insufficiency by exogenously altering the level of sulfatide in our body.3 Serum sulfatide and eGFR levels were negatively correlated with left atrium diameter.Compared with group C,group A had a gradually increased left atrial diameter as the level of serum sulfatide and eGFR decreased.B group compared with A group,serum sulfatide and glomerular filtration rate decreased significantly,can cause the ejection fraction decreased.Due to the enlargement of left atrium and the decline of the ejection fraction,it is an important predictor of the prognosis of atrial fibrillation,cardiac insufficiency and cardiovascular disease,suggesting that the joint monitoring of serum levels of sulfatide and eGFR may open up a new idea for delaying the progression of cardiac insufficiency. |
PDF Full Text Request