维持性血液透析患者骨硬化蛋白水平与血管钙化的相关性分析  

Correlation between serum Sclerostin level and vascular calcification in maintenance hemodialysis patients

作　　者：曹倩颖 周晶晶 刘小菁[1] 金立群 连晓英 李忠心[1] CAO Qian-ying;ZHOU Jing-jing;LIU Xiao-jing;JIN Li-qun;LIAN Xiao-ying;LI Zhong-xin(Department of Nephrology,Beijing Luhe Hospital,Capital Medical University,Beijing 101100,China.)

机构地区：[1]首都医科大学附属北京潞河医院肾病中心,北京101100

出　　处：《中国血液净化》2020年第2期103-107,共5页Chinese Journal of Blood Purification

摘　　要：目的探讨血清骨硬化蛋白(Sclerostin)与维持性血液透析(maintenance hemodialysis,MHD)患者腹主动脉钙化之间的关系。方法选择首都医科大学附属北京潞河医院肾病中心150名维持性血液透析为研究对象,收集患者的人口统计学资料及临床资料,包括有无糖尿病及残余尿量的统计,尿量<200ml则视为无残余肾功能(residual renal function,RRF)。同时用酶联免疫吸附法(ELISA)检测血清Sclerostin、骨特异碱性磷酸酶(bone specific alkaline phosphatase,BsAP)。通过腹部侧位X线片检测腹主动脉钙化(calcification of abdominal aorta,AAC)。分析Sclerostin水平与MHD患者iPTH、BsAP、腹主动脉钙化的相关关系。结果①首都医科大学附属北京潞河医院MHD患者腹主动脉钙化的发生率为74%,按照有无AAC将患者分为钙化组和无钙化组,结果显示钙化组Sclerostin、Kt/V明显低于无钙化组(t值分别为6.694,2.298;P值分别为<0.001,0.023),而年龄、透析龄、iPTH、血清碱性磷酸酶、BsAP均高于无钙化组(t值分别为-5.250,-4.356,-2.926,-3.877,-4.654;P值分别为<0.001,<0.001,<0.001,<0.001,<0.001),两组间性别、血钙、血磷等指标无统计学差异(t值分别为2.345,-0.262,0.096;P值分别为0.126,0.794,0.923)。②Logistic回归分析MHD患者血管钙化的危险因素:年龄(OR=1.134,95%CI 1.059~1.224,P<0.001)、透析龄(OR=1.006,95%CI1.006~1.075,P=0.019)、有无残肾(OR=0.150,95%CI 0.027~0.818,P=0.028)、有无糖尿病(OR=8.199,95%CI1.316~51.073,P=0.024)、iPTH(OR=1.009,95%CI 1.001~1.017,P=0.035)、Kt/V(OR=0.030,95%CI0.001~0.652,P=0.026)、Sclerostin(OR=0.985,95%CI 0.976~0.994,P=0.002)、BsAP(OR=1.295,95%CI 1.037~1.618,P=0.023)均有统计学意义。结论MHD患者血管钙化发生率高,高龄、透析龄长、糖尿病、高iPTH、高BsAP均为MHD患者血管钙化的危险因素,而有残余肾功能、Sclerostin、Kt/V是MHD患者血管钙化的保护因素。Objective To investigate the relationship between serum sclerostin and the degree of abdominal aortic calcification in patients undergoing maintenance hemodialysis(MHD). Methods 150 MHD patients in our hospital’s nephropathy center were selected as subjects, Collect patient demographic data and clinical data, Including diabetes and residual urine volume, urine volume <200 ml is considered as no residual renal function(RRF), Serum Sclerostin and bone specific alkaline phosphatase(BsAP) levels from 150 cases of MHD patients were measured by ELISA. Abdominal aortic calcification(AAC) was detected by lateral radiographs of the abdomen and AAC scores were performed. Analysis of the relationship between Sclerostin level and iPTH, BsAP and a AAC in patients with MHD. Results 1. The incidence of abdominal aortic calcification in patients with MHD was 74%. The patients were divided into calcified group and non-calcified group according to the presence or absence of AAC. The results showed that the sclerostin, kt/v in the calcified group was significantly lower than that in the non-calcified group(t=6.694,P<0.001). Age(t=-5.250,P<0.001), dialysis age(t=-4.356,P<0.001), iPTH(t=-2.926,P<0.001), serum alkaline phosphatase(t=-3.877,P<0.001), BsAP(t=-4.654,P<0.001)were higher than those without calcification(P<0.05). There were no significant differences in gender(t=2.345,P=0.126), serum calcium(t=-0.262,P=0.794) and phosphorus(t=0.096,P=0.923) between the two groups(P> 0.05). 2. Logistic regression analysis of risk factors for vascular calcification in patients with MHD: Age(OR=1.134, 95% CI, 1.059~1.224, P<0.001), dialysis age(OR=1.006, 95% CI, 1.006-1.075,P=0.019), RRF(OR=0.150, 95% CI, 0.027~0.818, P=0.028), Diabetes(OR=8.199, 95% CI, 1.316~51.073, P=0.024), iPTH(OR=1.009, 95% CI, 1.001~1.017,P=0.035), Kt/V(OR=0.030, 95% CI, 0.001~0.652, P=0.026), Sclerostin(OR=0.985, 95% CI, 0.976~0.994, P=0.002), BsAP(OR=1.295, 95% CI), 1.037~1.618, P=0.023) were statistically significant. Conclusion The incidence of vascular calcificat

关 键 词：骨硬化蛋白 维持性血液透析 血管钙化 骨代谢紊乱 

分 类 号：R459.5[医药卫生—治疗学]