The Correlation Between Serum Levels Of Pregnancy-Associated Plasma Protein-a And Intima-media Thickness Of Carotid In Patients With Chronic Kidney Disease

Objective:Detect changes in serum levels of Pregnancy-Associated Plasma Protein-A(PAPP-A)、high sensitive-C-reactive protein(Hs-CRP) and carotid ultrasound,in order to approach the correlation between serum levels of Pregnancy-Associated Plasma Protein-A(PAPP-A) 、 high sensitive-C-reactive protein(hs-CRP) and intima-media thickness of carotid in patients with chronic kidney disease.Methods:The experimental group:The experimental group: From January 2014 to August 2014,Seventy-one non-dialytic chronic kidney disease(CKD) patients(44 men, 27 women,mean age 44.95±12.86 years) were treated in the Second Hospital of Hebei Medicai University.The etiology of patients was chronic glomerulonephritis(69 cases),and autosomal dominant polycystic kidney disease(2cases).According CKD-EPI equation to assess glomerulai filtration rate(e GRF[ml/min/1.73m2]),All CKD patients were classified into 3 groups.24 CKD 3 patients( 14 men 10 women,mean age,42.17±13.55 years),17 CKD 4 patients( 14 men,3 women, mean age, 47.44±11.31 years) and 30 CKD 5 patients(16 men,14 women,mean age,46.79±13.24years).The control group:Sixteen age and sex matched healthy volunteers( 7 men, 9 women, mean age, 47.31±10.42 years) were selected as the normal control group.By ELISA to detect serum Pregnancy-Associated Plasma Protein-A and Immunoturbidimetric Assays to detect high sensitive-C-reactive protein in all subjects.High-resolution ultrasound was used to detect ntima-media thickness(IMT) of carotid and atherosclerotic plaques.Collected complete biood count,liver function,kidney functions,blood-lipid,IPTH and so on.Collected information of patients:such as sex,age,type of primary disease,with or without previous cardiovascular disease,blood pressure,Body mass index(BMI) and so on.Results:1 CKD patients with serum PAPP-A and Hs-CRP levels:Compared with the control group, the serum PAPP-A concentration was obviously increased in CKD patients and each CKD stage group.The serum PAPP-A concentration in CKD patients had statistical significance among different CKD stage.In CKD patients,the serum level of PAPP-A was increased with the GFR decreased.2 CKD patients with carotid ultrasound results:the value of IMT in patients with CKD was higher compare with the control groups.The value of IMT in CKD4 and CKD5 groups were obviously higher than that in the control group.3The relationship between serum PAPP-A 、 Hs-CRP and atherosclerosis :CKD patients with atherosclerosis of carotid artery serum PAPP-A and Hs-CRP leves were significantly higher than those in normal ones.4 CKD patients relationship with the micro-inflammatory state :Compared with the hs-CRP less than 8mg/L group,the value of IMT and PAPP-A was significance increased in hs-CRP more than 8mg/L group.5 The linear correlation analysis showed the serum levels of PAPP-A and hs-CRP were positively correlated with the value of IMT(r=0.521,P<0.001;r=0.456,P<0.001).The serum PAPP-A concentration was positively correlated with hs-CRP(r=0.955,P<0.01)).In patients with CKD,the serum levels of PAPP-A was positively correlated with body mass systolic blood pressure(SBP),blood urea nitrogen(BUN),Creatine(Scr),uric acid(UA)(r=0.342,P<0.01.r=0.7.1,P<0.01.r=0.666,P<0.01.r=0.241,P<0.01).Conclusion:1 Serum PAPP-A and Hs-CRP levels were closely related to carotid atherosclerosis in patients with CKD.2 PAPP-A was an independent risk factor for atherosclerosis.3 In patients with chronic kidney disease.The increased level of PAPP-A and micro-inflammatory state may both participate in pathogenesis and progression of atherosclerosis.4 Detect blood PAPP-A, Hs-CRP together combined carotid ultrasound may be the reliable indicator for chronic kidney disease patients with atherosclerosis in the early stage.