腹膜透析患者颈动脉钙化与胎球蛋白A及C反应蛋白的关系及对心血管事件的影响  

Association of vascular calcification, fetuin A, C- reaction protein and the influence on cardiovascular events in peritoneal dialysis patients

作　　者：梁剑波[1] 区景运[3] 王泽彬[1] 江丽屏[1] 詹俊琳[2] 

机构地区：[1]广州医学院第二附属医院肾内科,510162 [2]广州医学院第二附属医院儿科,510162 [3]开平市中心医院肾内科

出　　处：《中华肾脏病杂志》2013年第8期569-573,共5页Chinese Journal of Nephrology

基　　金：广东省科技计划项目（2007B031503009）

摘　　要：目的探讨腹膜透析患者颈动脉钙化与血浆胎球蛋白A（fetuin A）及C反应蛋白（CRP）之间的关系及其对心血管事件发生的影响。方法对60例腹膜透析患者进行颈总动脉内中膜厚度（cIMT）超声、胎球蛋白A、CRP及相关临床指标的检测，观察胎球蛋白A、CRP等生化指标对腹膜透析患者动脉钙化的影响。随访18个月，观察cIMT、胎球蛋白A及CRP等指标与腹膜透析患者心血管事件发生的关系。结果60例腹膜透析患者中，38例（63.3％）存在cIMT增厚。与无cIMT增厚患者相比，重度cIMT增厚患者血浆胎球蛋白A水平较低（P〈0．05），CPR（P〈0．05）及钙磷乘积（P〈0．05）较高；与轻度cIMT增厚患者相比，重度cIMT增厚患者血浆胎球蛋白A水平较低（P〈0．05），钙磷乘积较高（P〈0．05）。直线回归分析结果显示，胎球蛋白A与CRP（序=0．629，F=47．522，P〈0．01）及钙磷乘积（R^2=0．299，F=11．948，P=0．002）均呈负相关；多元回归分析显示，腹膜透析患者的cIMT与胎球蛋白A呈负相关（B=-0．019，t=-6．042，P〈0．01）。随访18月，发生心血管事件36例次，因心血管事件死亡6例，Logistic回归分析显示，cIMT增厚是心血管事件发生的重要危险因素（Wald值=7．698，OR=3．691，95％CI1．467～9．258，P：0．006）。结论胎球蛋白A降低及钙磷乘积升高是腹膜透析患者颈动脉钙化的重要危险因素。腹膜透析患者体内微炎性反应状态（CRP升高）导致胎球蛋白A的水平下降，引起钙磷乘积升高，从而促进颈动脉钙化的发生。cIMT增厚是腹膜透析患者心血管事件的危险因素。Objective To investigate the association of vascular calcification, fetuin A and C- reaction protein （CRP）, and explore the influence on cardiovascular events. Methods Sixty peritoneal dialysis （PD） patients were enrolled in this study. Carotid intima-media thickness （cIMT）, fetuin A and CRP, along with the other serum related parameters were detected to find out their influence on vascular calcification in PD patients. The relationship between cIMT, fetuin A, CPR and cardiovascular events was analyzed in PD patients with 18 months followed-up. Results Of the 60 PD patients, carotid intima-media thickness （cIMT） was increased in 38 patients（63.3%）. Compared with the non-increased cIMT patients, serum fetuin A concentration was significantly decreased（P 〈 0.05）,CRP（P〈0.01） and calcium x phosphate products（P〈0.05） were significantly increased in the high- increased cIMT group. Compared with the low-increased cIMT patients, fetuin A concentration was obviously lower（P 〈 0.05） and calciumxphosphate products were obviously higher（P 〈 0.05） in the high- increased cIMT group. Linear regression analysis discovered an obvious negative correlation between CRP and fetuin A（R^2 = 0.629, F= 47.522, P 〈 0.01）, as well as fetuin A and calciumxphosphate products （R^2=0.299, F= 11.948, P=0.002）. Multiple regression analysis indicated that fetuin A was independently negatively correlated with cIMT（B=-0.019, t=-6.042, P〈0.01）. At 18 months, there were 36 newly- happened cardiovascular events and among which 6 cases died. Logistic regression analysis found that increased cIMT was risk factor to cardiovascular events in PD patients（OR = 3.691, 95%CI1.467-9.258,P=0.006）. Conclusion Decreased fetuin A and increased calciumxphosphate products deteriorate carotid calcification in PD patients. Micro-inflammation of PD patients represented by high CRP levels may increase calciumxphosphate products by depressing the fetuin A level, and in the end will stimulate carotid ca

关 键 词：心血管疾病 腹膜透析 C反应蛋白 胎球蛋白A 血管钙化 

分 类 号：R459.5[医药卫生—治疗学]