腹膜透析患者血清肌腱蛋白-C与腹主动脉钙化的相关研究  

Serum Tenascin-C and Abdominal Aortic Calcification in Peritoneal Dialysis Patients

作　　者：刘媛[1] 隋小妮[1] 王安阳 王俊楠 任彩霞 万美燕[1] LIU Yuan;SUI Xiaoni;WANGAnyang;WANG Junnan;REN Caixia;WAN Meiyan(Department of Nephrology,Qingdao Municipal Hospital of Qingdao University,Qingdao 266011,China)

机构地区：[1]青岛大学附属青岛市市立医院肾内科

出　　处：《中国全科医学》2020年第3期312-318,共7页Chinese General Practice

基　　金：青岛市市立医院总院长创新研究基金资助项目(ZYZJJ2018031)

摘　　要：背景动脉粥样硬化性心血管疾病(CVD)是终末期肾脏病(ESRD)患者致残和致死的主要原因,近年来大量研究发现血管钙化是引起ESRD患者发生CVD的一个关键危险因素,目前已有动物及细胞水平的研究发现血清肌腱蛋白-C(TN-C)参与血管钙化机制,但临床研究相对少见。目的研究腹膜透析(PD)患者血清TN-C水平及腹主动脉钙化的情况及其相关因素,并分析该人群二者之间的相关性。方法选择2017年9月2018年10月在青岛市市立医院肾内科持续不卧床腹膜透析(CAPD)≥3个月的80例患者。收集其临床资料,采用酶联免疫吸附试验(ELISA)检测其血清TN-C水平,腹部侧位X线平片评估腹主动脉钙化程度,计算腹主动脉钙化积分(ACCs)。以血清TN-C中位数为界,分为低TN-C组和高TN-C组。依据患者AACs分为无和轻度钙化组(0≤AACs≤4分)、中重度钙化组(>4分)。采用多因素Logistic回归分析研究PD患者TN-C、腹主动脉钙化的危险因素,采用受试者工作特征(ROC)曲线评价TN-C预测PD患者发生腹主动脉钙化的临床价值。结果本研究80例PD患者中位TN-C水平为63.27(60.78,66.56)μg/L,低TN-C组40例,高TN-C组40例。发生腹主动脉钙化患者66例(82.5%),无和轻度钙化组38例,中重度钙化组42例。高TN-C组患者透析龄大于低TN-C组(P<0.01)。中重度钙化组患者的年龄和透析龄大于无和轻度钙化组,原发病为糖尿病肾病比例高于无和轻度钙化组(P<0.05)。高TN-C组患者甲状旁腺激素、血钙、TN-C、AACs高于低TN-C组(P<0.05)。中重度钙化组患者的甲状旁腺激素、血磷、碱性磷酸酶、TN-C、AACs高于无和轻度钙化组(P<0.05)。TN-C与患者的年龄、透析龄、甲状旁腺激素、血钙、AACs水平呈正相关(rs=0.29、0.41、0.54、0.35、0.73,P<0.01),与清蛋白水平呈负相关(rs=-0.23,P<0.05)。多因素Logistic回归分析结果显示,血清甲状旁腺激素较高[OR=1.003,95%CI(1.000,1.005),P<0.05]和高AACs[OR=1.148,9Background Atherosclerotic cardiovascular disease(CVD) is the leading cause of disability and death in patients with end-stage renal disease(ESRD).In recent years,a large number of studies have found that vascular calcification is a key risk factor for CVD in patients with ESRD.Studies on animals and at cell level have found that tenascin-C(TN-C) is involved in the mechanism of vascular calcification,but clinical studies are relatively rare.Objective To investigate the serum tenosin-C(TN-C) level,abdominal aortic calcification and related factors in patients with peritoneal dialysis (PD),and to analyze their correlation in this population.Methods Eighty patients with continuous ambulatory peritoneal dialysis(CAPD) for more than 3 months in Qingdao Municipal Hospital were selected from September 2017 to October 2018.Their clinical data were collected.The levels of serum TN-C were detected by enzyme-linked immunosorbent assay (ELISA).Abdomen lateral plain was used as a criterion to determine the abdominal aortic calcification.The abdominal aortic calcification score(AACs) was calculated.According to the median TN-C level,the patients were divided into low TN-C group and high TN-C group.According to AACs,the patients were divided into the non-and mild calcification group (0≤AACs≤4 points) and the moderate-to-severe calcification group(>4 points).Logistic regression analysis was used to determine the risk factor of abdominal aortic calcification and TN-C in PD patients.The receiver operating characteristics(ROC) analysis was applied to evaluate the predict value of TN-C in abdominal aortic calcification.Results In this study,the median serum TN-C level was 63.27(60.78,66.56)μg/L,and 40 patients were in the low TN-C group,40 patients in the high TN-C group.There were 66 patients(82.5%) with abdominal aortic calcification,38 patients were in the non-and mild calcification group and 42 patients in the moderate-to-severe calcification group.The dialysis age of patients in the high TN-C group was greater than that in

关 键 词：腹膜透析 持续不卧床 肌腱蛋白-C 血管钙化 

分 类 号：R459.5[医药卫生—治疗学]