维持性血液透析患者血清RANKL、OPG及FGF21与冠状动脉钙化的关系  

Association of serum concentrations of RANKL,OPG,FGF21 with coronary artery calcification in maintenance hemodialysis patients

作　　者：谢双燕 崔燕海 陈芸芝 陈雪芹 李博厚 刘双信 何朝生 XIE Shuang-yan;CUI Yan-hai;CHEN Yun-zhi;CHEN Xue-qin;Li Bo-hou;LIU Shuang-xin;HE Chao-sheng(The Second School of Clinical Medicine,Southern Medical University,Guangzhou 510080,China;De-partment of Nephrology,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Radiology,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Guangdong Provincial People′s Hospital,Guang-dong Academy of Medical Sciences,Guangzhou 510080,China;School of Medicine,South China University of Technology,Guangzhou 510006,China)

机构地区：[1]南方医科大学第二临床医学院,广州510515 [2]广东省人民医院(广东省医学科学院)肾内科,广州510080 [3]广东省人民医院(广东省医学科学院)影像科,广州510080 [4]广东省人民医院(广东省医学科学院),广州510080 [5]华南理工大学医学院,广州511436

出　　处：《岭南心血管病杂志》2022年第2期165-170,共6页South China Journal of Cardiovascular Diseases

基　　金：广东省科技厅计划项目(项目编号:2015A020210069);广东省科技厅计划项目(项目编号:2014A020209001)。

摘　　要：目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者血清核因子NF-κB受体活化因子配体(receptor activatorofNF-κB ligand,RANKL)、骨保护素(osteoprotegerin,OPG)及成纤维细胞生长因子21(fibroblast growthfactor 21,FGF21)浓度与冠状动脉钙化及其进展的关系。方法选取2018年1月至2020年12月在广东省人民医院进行MHD的患者178例,收集患者基本资料,利用酶联免疫吸附试验法(enzymelinked immunosorbent assay,ELISA)检测血清OPG、RANKL、FGF21浓度,使用多层螺旋计算机断层扫描(mul⁃tislice spiralcomputedtomography,MSCT)测定冠状动脉钙化积分(coronary arterycalcificationscore,CACs),行相关性分析。结果178例MHD患者重度冠状动脉钙化(CACs>400分)发生率为54.5%。与轻度冠状动脉钙化(10分<CACs<400分)比较,重度冠状动脉钙化组的血清OPG浓度显著升高,差异有统计学意义(P<0.05)。Spearman相关分析显示OPG与CACs成正相关关系(r=0.217,P=0.004);OPG对重度冠状动脉钙化的受试者工作特征曲线(receiver operatingcharacteristiccurve,ROC)的曲线下面积为0.66。RANKL、FGF21浓度在不同钙化分组患者间比较,差异无统计学意义(P<0.05)。透析患者血清FGF21浓度较健康人群显著升高,约11倍左右,差异有统计学意义(P=0.000)。结论MHD患者重度冠状动脉钙化发生率高血清OPG浓度与冠状动脉钙化严重程度相关,是评估MHD患者冠状动脉钙化进展的较良好指标。Objectives ligand(RANKL),osteoprotegerin(OPG),fibroblast growth factor 21(FGF21)and coronary artery calcification in patients with maintenance hemodialysis(MHD).Methods Guangdong Provincial People′s Hospital from January 2018 to December 2020 were collected retrospectively. The serum concentrations of OPG,RANKL and FGF21 were detected by enzyme-linked immunosorbent assay(ELISA),and the coronary artery calcification score(CACs)was measured by multislice spiral computed tomography(MSCT).Results The incidence of severe coronary artery calcification(CACs > 400)was 54.5%. In comparison with the light coronary artery calcification group(10 400). Spearman correlation analysis showed that OPG positively correlated with CACs. Receiver operating characteristic curve(ROC)revealed that the area under the curve(AUC)was 0.66 for serum concentration of OPG in diagnosis of severe coronary calcification. There was no significant difference in serum concentrations of RANKL and FGF21 in patients without coronary artery calcification,with mild coronary artery calcification and severe coronary artery calcification. Serum concentration of FGF21 in dialysis patients was significantly higher than that in healthy subjects,about 11-fold(P=0.000).Conclusions high in patients with MHD,and the serum concentration of OPG correlates with the severity of coronary calcification. It is a good index to evaluate the progression of coronary artery calcification in patients with MHD.

关 键 词：冠状动脉钙化 血液透析 核因子NF-κB受体活化因子配体 骨保护素 成纤维细胞生长因子21 

分 类 号：R541.4[医药卫生—心血管疾病]