The Study On The Levels Of Serum PLGF、sFlt-1 And The Correlation Between Carotid Antherosclerosis In Patients With Moderate And Advanced Stage Chronic Kidney Disease

Objective: The number of patients with chronic kidney disease increased year by year and has a high prevalence of atherosclerosis,however the specific molecular mechanism is not fully understood.VEGF plays an important role in the development and progression of atherosclerosis,its ligands PLGF and target receptor s Flt-1 regulate the biological function of VEGF,but their role in atherosclerosis in patients with chronic CKD is unclear.This article aim to approch the correlation between serum levels of PLGF and s Flt-1 with carotid ultrasound in CKD patients.To explore the mechanism of atherosclerosis in patients with CKD and provides the basic for prevention and treatment of atherosclerosis in CKD patients.Methods: 62 patients with no-dialysis kidney disease who is outpatient and hospitalized patients were recruited in the Affiliated Hospital of North Sichuan Medical College from Feb 2014 to Sep 2014.According the American Kidney Foundation guidelines for patients with CKD divided the 62 patients into 3 groups:stage CKD3 group 21 cases,CKD4 group 19 cases,CKD5 group 22 cases.Select 20 healthy subjects in the same period in our hospital as normal control group. Record each group subject’ smoking rates,weight,urea nitrogen(Urea), creatinine(Crea), triglyceride(TG), cholesterol(TC), low-density lipoprotein(LDL), high-density lipoprotein cholesterol(HDL), albumin(Alb) and other clinical indicators. ELISA was used for measurement of serum levels of PLGF and s Flt-1. Using high-resolution real-time color ultrasonic diagnostic instrument testing carotid intima-media thickness(IMT) and the presence of carotid plaques in each object.Using SPSS13.0 statistical analysis software,with P<0.05 for the difference was statistically significant.Results:1. Serum levels of s Flt-1and PLGF in Patients with moderate and advanced stage Chronic Kidney Disease: Compared with the control group the serum s Flt-1 concentration was decresed in CKD3-5 stage patients(P<0.05),and with the decline of e GFR s Flt-1 level has a downward trend,Compared with the control group the serum PLGF concentration was obviously increased in CKD3-5 stage patients(P<0.05),and with the decline of e GFR PLGF level has a upward trend.2. Carotid artery ultrasound results in Patients with moderate and advanced stage Chronic Kidney Disease: CKD3-5 stage patients who with carotid artery IMT thickness,IMT thickening rate and incidence of plaque is higher than healthy controls(P<0.05).3. Relationship of atherosclerosis and serum PLGF,s Flt-1 level in Patients with moderate and advanced stage Chronic Kidney Disease: According to the results of carotid artery ultrasound in patients with CKD divided into 3 groups : the IMT thickened without plaque group,plaques group and normal group.The serum s Flt-1 level in plaque group is lower than the IMT thickend without plaques group and normal group(P<0.05).The serum PLGF level in plaque group were higher than the IMT thickened without plaque group and normal group(P<0.05).Serum s Flt-1 level in IMT thickened without plaque group lower than normal group(P<0.05),Serum PLGF level in IMT thickened without plaque group higher than normal group(P<0.05).4.The correlation analysis among s Flt-1,PLGF,IMT and e GFR in Patients with moderate and advanced stage Chronic Kidney Disease: The serum level of s Flt-1 was negatively correlated with carotid IMT(r=-0.321,P<0.05)and was positively correlated with e GFR(r=0.701, P<0.05),The serum level of PLGF was positively correlated with carotid IMT(r=0.662,P<0.05)and was negatively correlated with e GFR(r=-0.619, P<0.05).The serum level of PLGF was negatively correlated with serum level of s Flt-1(r=-0.451,P<0.05).There was no correlation between e GFR and carotid IMT(P>0.05).5.Multiple linear regression analysis shows that: in Patients with moderate and advanced stage Chronic Kidney Disease PLGF(β=0.537,P<0.01),TG(β=0.233,P<0.05)were independent factors of carotid IMT and s Flt-1(β=-0.231,P<0.05) is protective factor of carotid IMT.Conclusion: 1. In Patients with moderate and advanced stage Chronic Kidney Disease with a higher incidence of carotid atherosclerosis. 2.Serum levels of s Flt-1 was significantly decreased and PLGF was significantly increased in Patients with moderate and advanced stage Chronic Kidney Disease. 3.The serum levels decrease of s Flt-1 and increase of PLGF is related to the development of carotid artery atherosclerosis in Patients with moderate and advanced stage Chronic Kidney Disease,can be used as markers of atherosclerosis in CKD.