老年不同肾功能患者血清胱抑素C与骨转换标志物的相关性  

Association between serum cystatin C and bone turnover markers in elderly patients with different renal function

作　　者：李学宇[1] 朱昀[1] 张帆[1] Li Xueyu;Zhu Yun;Zhang Fan(Department of Geriatrics-Peking Utiiziersity Third Hospitai,Beijing 100191,China)

机构地区：[1]北京大学第三医院老年内科,100191

出　　处：《中华老年医学杂志》2021年第11期1392-1395,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨血清胱抑素C(CysC)与骨转换标志物间的关系,并比较不同肾功能老年患者的水平.方法回顾性病例对照研究,连续纳入2019年6月至2020年6月北京大学第三医院老年内科住院并进行血清CysC和骨转换标志物检查的老年患者74例,年龄61~97(79.5±8.7)岁,其中男性40例,女性34例.根据估算肾小球滤过率(eGFR)分为慢性肾病(CKD)G3-G5期组(eGFR<60 ml·min-1·1.73 m-2)32例和CKD G1-G2期组(eGFR≥60 ml·min-1·1.73 m-2)42例,其中明确诊断骨质疏松21例.生化分析仪检测血清CysC,电化学发光法检测血清骨转换标志物Ⅰ型胶原交联C-末端肽β-降解产物(β-CTX)和Ⅰ型前胶原氨基端前肽(P1NP)及骨代谢相关指标25-羟维生素D3[25(OH)D3]、甲状旁腺素(PTH),分析上述指标在两组患者间的差异.Pearson相关分析CysC与骨转换标志物的相关性,多重线性回归分析骨转换指标的相关因素.结果CKDG3-G5期组患者的β-CTX、P1NP及PTH均高于CKD G1-G2期组,25(OH)D3低于CKD G1-G2期组,但差异无统计学意义(均P>0.05).CKD G3-G5期组中,CysC与骨吸收标志物β-CTX和骨形成标志物P1NP相关(r值分别为0.598,0.519,均P<0.01);CKD G1-G2期组中,CysC与β-CTX无相关性(r=-0.030,P>0.05),CysC与P1NP相关(r=0.342,P<0.05).对74例患者和21例确诊骨质疏松患者分别进行多重线性回归结果显示,CysC是P1NP的独立相关因素(β值分别为19.19,28.78,P<0.01和P<0.05).结论对中度及以上肾功能下降的老年患者,较高的CysC提示较高的骨转换.对不同肾功能状态的老年患者,CysC与是骨形成标志物P1NP的独立相关因素,提示CysC可能反映骨保护作用.Objective To observe the association between serum cystatin C(CysC)and bone turnover markers levels in elderly chronic kidney disease(CKD)patients with different estimated glomerular filtration rate(eGFR).Methods A total of 74 elderly patients aged 61-97(79.5+8.7)years with 40 males»receiving serum CysC and bone turnover markers tests,were recruited in the Department of Geriatrics,Peking University Third Hospital from June 2019 to June 2020.They were divided into normal eGFR group(Gl and G2 stage)(eGFRN 60 ml·min^(-1)·1.73 m^(-2).n=42)and decreased eGFR group(G3-G5 stage)(eGFR<C 60 ml·min^(-1)·1.73 m^(-2),n=32).Serum levels of CysC and bone turnover markersCp-isomerized C-terminal telopeptides(β-CTX)and procollagen type I N-terminal propeptide(Pl NP)]were tested.The association between CysC and bone turnover markers was analyzed.Results The levels of β-CTX,PlNP and parathyroid hormone(PTH)were higher in decreased eGFR group(G3-G5 stage)than in normal eGFR group(G1 and G2 stage)»and 25(OH)D3 was lower in decreased eGFR group(G3-G5 stage)than in normal eGFR group(Gl and G2 stage),but the differences were not statistically significant(all P>0.05).In decreased eGFR group(G3-G5 stage),CysC had significant association with β-CTXG=O.598,P<0.01)and P1NP(r=0.519,P<0.01),respectively.In normal eGFR group(G1 and G2 stage),CysC was significantly related with P1NP(r=0.342,p<0.05),and CysC had no correlation with β-CTX(r=-0.030,P>0.05).Multiple regression analysis showed that CysC was independently positively associated with P1NP in total 74 subjects(0=19.19,P < 0.01),and in 21 osteoporosis patients(β=28.78,P < 0.05).Conclusions In elderly patients with moderate and severe renal dysfunction,a higher CysC level indicates higher bone turnovers.CysC is independently positively associated with the bone formation marker Pl NP,suggesting CysC may reflect a bone protective effect in elderly patients with different renal function.

关 键 词：胱抑素C 肾机能不全 慢性 骨质疏松 

分 类 号：R692[医药卫生—泌尿科学]