维持性血液透析患者血清Sclerostin与血管钙化相关性分析  

The correlation analysis of serum sclerostin and vascular calcification in maintenance hemodialysis patients

作　　者：吴雪莹[1] 张琢[1] 徐天华[1] 杜银科[1] 王力宁[1] 姚丽[1] 

机构地区：[1]中国医科大学附属第一医院肾脏内科,沈阳110001

出　　处：《中国血液净化》2017年第12期793-797,共5页Chinese Journal of Blood Purification

基　　金：国家重点研发计划"全国罕见病队列研究"(2016YFC0901501);辽宁省自然科学基金"Micro RNA-30b调控自噬在慢性肾脏病血管钙化的作用及机制研究"(20170540999);沈阳市科学技术计划项目"Sclerostin/Lrp4调节VSMC成骨分化影响CKD血管钙化的机制研究"(F16-206-9-04)

摘　　要：目的观察维持性血液透析(maintenance hemodialysis,MHD)患者血管钙化发生情况,探讨MHD患者血清骨硬化蛋白(Sclerostin)与血管钙化的关系。方法选取2015年6月~2016年6月于中国医科大学附属第一医院MHD患者30例为实验组,选取健康对照组30例,腹部侧位X线片评估腹主动脉钙化,检测血清Sclerostin、钙、磷、全段甲状旁腺激素、镁、25羟维生素D、血清白蛋白(albumin,ALB)等指标。结果实验组与对照组血管钙化发生率有明显差异(χ2=9.317,P=0.005),2组血管钙化积分也有明显差异(t=2.330,P=0.023),实验组Sclerostin水平是对照组Sclerostin水平的3~4倍[(4.81±1.18)ng/ml比(1.25±0.61)ng/ml,t=14.162,P<0.001]。MHD患者血管钙化组的Sclerostin水平低于非血管钙化组(t=2.697,P=0.012),Spearman相关分析MHD患者血管钙化与血清Sclerostin水平呈负相关(r=-0.500,P=0.005),与年龄(r=0.588,P=0.001)、透析龄(r=0.417,P=0.022)、磷(r=0.741,P<0.001)、钙磷乘积(r=0.612,P<0.001)、全段甲状旁腺激素(r=0.588,P=0.001)、镁(r=0.470,P=0.009)等指标呈正相关。Sclerostin水平较高组的血管钙化积分低于Sclerostin水平较低组(t=-2.324,P=0.026)。ROC曲线分析,Sclerostin预测血管钙化的曲线下面积为0.707(95%CI 0.579~0.834,P=0.020),最佳截断值2.03ng/ml,灵敏度100%,特异度60.9%。结论 MHD患者血管钙化发生率高、程度重,血管钙化与血清Sclerostin水平负相关,与年龄、透析龄、血磷、钙磷乘积、血清全段甲状旁腺激素、血镁等指标正相关。血清Sclerostin可能是一种血管钙化的保护因素,对预测血管钙化有重要作用。Objective To observe the incidence of vascular calcification and to analyze the relationship between serum sclerostin and vascular calcification in maintenance hemodialysis （MHD） patients. Methods A total of 30 cases on long-term MHD treated from June 2015 to June 2016 in the First Affiliated Hospital of China Medical University were recruited as the experiment group;30 normal individuals were selected as the control group. Their abdominal aorta calcification was evaluated by abdominal X-ray. Serum sclerostin, calci-um, phosphorus, immunoreactive parathyroid hormone （iPTH）, magnesium, 25-hydroxyvitamin D, albumin and other indices were recorded. Results Vascular calcification rate was significant different between experi-ment group and control group （χ2=9.317, P=0.005）, and so did the vascular calcification score （t=2.330, P=0.023）. Serum sclerostin was 3-4 times higher in experiment group than in control group （t=14.162, P〈0.001）. In experiment group, serum sclerostin level was lower in the MHD patient with vascular calcification than those without vascular calcification （t=2.697, P=0.012）. Spearman correlation analysis showed that vas-cular calcification in MHD patients was negatively correlated with sclerostin level （r=-0.500, P=0.005）, and was positively correlated with age （r=0.588, P=0.001）, dialysis age （r=0.417, P=0.022）, phosphorus （r=0.741, P〈0.001）, calcium and phosphorus product （r=0.612, P〈0.001）, total parathyroid hormone （r=0.588, P=0.001） and magnesium （r=0.470, P=0.009）. Vascular calcification score was lower in MHD patients with high-er serum sclerostin than in those with lower serum sclerostin （t=-2.324, P =0.026）. ROC curve analysis showed that the area under the curve of serum Sclerostin for prediction of vascular calcification was 0.707（95%CI：0.579~0.834, P=0.020） with the optimal cut-off value of 2.03 ng/mL, the sensitivity of 100%and specificity of 60.9%. Conclusion The incidence and the degree of vascular calcification w

关 键 词：骨硬化蛋白 血管钙化 维持性血液透析 终末期肾脏病 

分 类 号：R318.16[医药卫生—生物医学工程]