血清可溶性KLOTHO蛋白与腹膜透析患者矿物质骨代谢及腹主动脉钙化相关性的研究  

Clinical study of the relationship between serum soluble Klotho protein and the abnormalities of mineral-bone metabolism and abdominal aortic calcification in peritoneal dialysis patients

作　　者：仲思[1,2] 范秋灵[1] 卢新星[2] 苏彦[2] 张东成[2] 王力宁[1] 

机构地区：[1]中国医科大学附属第一医院肾内科,沈阳110016 [2]辽宁省人民医院肾内科,沈阳110016

出　　处：《中国血液净化》2015年第9期525-529,共5页Chinese Journal of Blood Purification

基　　金：国家自然科学基金(81270808);辽宁省科技厅社会发展攻关计划(2012225019)

摘　　要：目的探讨血清可溶性Klotho蛋白(s KL)与持续性非卧床腹膜透析(CAPD)患者矿物质骨代谢指标及腹主动脉钙化的关系。方法 58例接受腹膜透析治疗>3个月以上且临床病情稳定的患者被纳入研究范围,收集患者的临床资料和血钙、磷、甲状旁腺激素(i PTH)、25-羟维生素D等生化指标。用ELISA法测定血清中可溶性Klotho蛋白(s KL)、人成纤维生长因子23(FGF23)、人骨特异性碱性磷酸酶(BAP)浓度。应用腹部侧位片评价患者腹主动脉钙化程度,计算腹主动脉钙化积分(AAC)。采用Pearson相关性分析的方法分析s KL与AAC及临床指标的关系,用logistic回归的方法分析CAPD患者发生腹主动脉钙化的危险因素,受试者工作特征曲线(ROC)评价s KL诊断腹主动脉钙化的准确性与特异性。结果58例腹膜透析患者中50发生腹主动脉钙化,钙化发生率为86.2%,血清s KL的浓度157.87±33.49 pg/m L。s KL浓度与AAC积分、血磷、FGF23呈负相关(r分别为-0.73、-0.26、-0.33,三者均P<0.05),与25-羟维生素D呈正相关(r=0.48,P<0.05),与BAP、PTH、血矫正钙无相关性(r分别为-0.17、-0.23、-0.04,P分别为0.21、0.09、0.75)。多因素Logistic回归分析结果显示:血清s KL降低(β=0.038,OR=0.96,P<0.05)和FGF23(β=0.08,OR=1.09,P<0.05)是CAPD患者腹主动脉钙化的独立危险因素。ROC曲线下面积(AUC)示s KL诊断腹主动脉钙化的AUC=0.81(截点为153.78 pg/m L,准确性为87.5%,特异性58.0%)。结论血清可溶性Klotho蛋白与腹膜透析患者的矿物质骨代谢异常相关,随着血清可溶性Klotho蛋白浓度的下降,腹主动脉钙化的风险升高,血清可溶性Klotho蛋白可以作为血管钙化的生物标志物。Objective To assess the relationship between serum soluble Klotho protein （sKL） and the abnormalities of mineral-bone metabolism and abdominal aortic calcification in continuous ambulatory perito- neal dialysis （CAPD） patients. Methods Fifty eight CAPD patients were prospectively studied. Their clini- cal data and biochemical indicators including serum calcium, phosphorus, intact parathyroid hormone （iPTH）, and 25-hydroxy vitamin D were analyzed. Serum sKL, fibroblast growth factor 23 （FGF23）, and bone-specif- ic alkaline phosphatase （BAP） were detected by ELISA. The diagnosis of abdominal aortic calcification was based on the images on abdomen lateral X-ray plain film, from which the abdominal aortic calcification score （AAC） was calculated. Linear correlation was used to analyze the relationship between sKL and biochemical indicators and AAC. Logistic regression analysis was performed to determine the risk factors for abdominal aortic calcification in CAPD patients. The receiver operating characteristic （ROC） curve was applied to evalu- ate the diagnostic value of sKL for abdominal aortic calcification. Results Fifty patients （86.2%） had ab- dominal aortic calcification, and serum sKL was 157.87±33.49 pg/mL. Serum sKL concentration was nega- tively correlated with AAC, phosphorus, and FGF23 Q=-0.73, P〈0.05; r=-0.26, P〈0.05; 1=-0.33, P〈0.05, respectively）, positively correlated with 25-hydroxy vitamin D （r=0.48, P〈0.05）, but not correlated withBAP, iPTH, and corrected serum calcium （r=-0.17, P=-0.21; r=-0.23, P=-0.09;r=-0.04, P=0.75; respectively）. Multivariate logistic regression analysis showed that lower serum sKL level and FGF23 were the independent risk factors for abdominal aortic calcification. ROC analyses for serum sKL in the diagnosis of abdominal aor- tic calcification showed that the sensitivity and specificity was 87.5% and 58.0%, respectively, when serum sKL was set at 153.78 pg/ml （AUC=0.91）. Conclusions In CAPD patients, serum sKL was correla

关 键 词：腹膜透析(CAPD) 血管钙化 人成纤维生长因子23(FGF23) 可溶性Klotho 

分 类 号：R459.5[医药卫生—治疗学]