CHI3L1水平与不同性别腹膜透析患者腹主动脉钙化的相关性研究  

Gender-specific association between serum CHI3L1 and abdominal aortic calcification in peritoneal dialysis patients

作　　者：周思佳 何莲[1] 韩庆烽[1] 唐雯[1] 张爱华 ZHOU Si-jia;HE Lian;HAN Qing-feng;TANG Wen;ZHANG Ai-hua(Department of Nephrology,Peking University Third Hospital,Beijing 100191,China;Department of Nephrology,Xuanwu Hospital Capital Medical University,Beijing100053,China)

机构地区：[1]北京大学第三医院肾内科,北京100191 [2]首都医科大学宣武医院肾内科,北京100053

出　　处：《中国血液净化》2022年第4期225-230,共6页Chinese Journal of Blood Purification

基　　金：国家自然科学基金项目(81873619、81570663);北大百度基金资助项目(2020BD030);中华国际医学交流基金会基金(Z-2017-24-2037)。

摘　　要：目的探究血清壳多糖酶3样蛋白1(chitinase-3-like protein 1,CHI3L1)水平与不同性别腹膜透析(peritoneal dialysis,PD)患者血管钙化的相关性。方法本研究为横断面研究,研究对象为116例行规律PD治疗超过6个月的慢性肾衰竭患者,利用侧位腹平片评估入组患者腹主动脉钙化(abdominal aortic calcification,AAC)程度。根据Kauppila评分系统行AAC评分,AAC评分<4为低AAC评分组,AAC评分≥4为高AAC评分组。收集患者的人口统计学资料、实验室化验数据。利用生物电阻抗原理测定体成分。通过酶联免疫吸附法测定血清CHI3L1。结果共纳入男性PD患者56例、女性60例,平均年龄(57.0±13.7)岁,61例(52.6%)患者AAC评分≥4。女性PD患者血清CHI3L1水平高于男性(Z=-3.435,P=0.001)。男性PD患者高AAC评分组的血清CHI3L1水平高于低AAC评分组,但差异不显著[(285.9±100.3)ng/ml比(238.4±106.8)ng/ml,t=-1.701,P=0.095];女性PD患者高AAC评分组的血清CHI3L1水平高于低AAC评分组[437.7(314.2,459.2)ng/ml比273.4(177.6,368.6)ng/ml,Z=-3.600,P<0.001]。女性PD患者血清CHI3L1与AAC评分呈正相关(r=0.590,P<0.001);男性PD患者血清CHI3L1与AAC评分相关性不显著(r=0.194,P=0.155)。多元Logistic回归分析提示血清CHI3L1(OR=1.012,95%CI:1.005~1.019,P=0.001)、血磷>1.45mmol/L(OR=5.596,95%CI:1.345~23.278;P=0.018)是女性PD患者AAC评分≥4的独立影响因素;年龄(OR=1.138,95%CI:1.026~1.262,P=0.014)、舒张压(OR=0.927,95%CI:0.861~0.997,P=0.042)、血清超敏C反应蛋白(OR=1.169,95%CI:1.003~1.361;P=0.046)及骨骼肌含量(OR=0.829,95%CI:0.696~0.987,P=0.035)是男性PD患者AAC评分≥4的独立影响因素。结论高水平血清CHI3L1与女性PD患者AAC独立相关,但不是男性PD患者AAC的独立影响因素。Objective To investigate the association between serum chitinase-3-like protein 1(CHI3L1)and vascular calcification in peritoneal dialysis(PD)patients of different genders.Methods In this cross-sectional study,a total of 116 patients with chronic renal failure treated with PD over 6 months were recruited.Lateral plain X-ray films of abdomen were used to evaluate the abdominal aortic calcification(AAC)score according to the Kauppila scoring system.Patients were divided into the low AAC score group(AAC score<4)and the high AAC score group(AAC score≥4).Demographic data and laboratory measurements were collected.Bioelectrical impedance analysis was applied to examine the body composition of these PD patients.Serum CHI3L1 was measured by enzyme-linked immunosorbent assay.Results Fifty-six males and 60 females were recruited.The mean age was 57.0±13.7 years and 61 patients(52.6%)had an AAC score≥4.Serum CHI3L1 of the female patients was significantly higher than that of the male patients(Z=−3.435,P=0.001).Among male patients,there was a trend that serum CHI3L1 of the high AAC score group was higher than that of the low AAC score group,but the result was not significant(285.9±100.3ng/ml versus.238.4±106.8ng/ml,t=−1.701,P=0.095).Among female patients,serum CHI3L1 of the high AAC score group was significantly higher than that of the low AAC score group[437.7(314.2,459.2)ng/ml versus.273.4(177.6,368.6)ng/ml,Z=−3.600,P<0.001].Serum CHI3L1 was positively correlated with the AAC score in the female patients(r=0.590,P<0.001),but not in the male patients(r=0.194,P=0.155).Multivariate logistic regression analysis showed that serum CHI3L1(OR=1.012,95%CI 1.005~1.019,P=0.001)and serum phosphate(>1.45mmol/L or not)(OR=5.596,95%CI 1.345~23.278,P=0.018)were independent related factors of high AAC score(AAC score≥4)in the female patients.However,age(OR=1.138,95%CI 1.026~1.262,P=0.014),diastolic blood pressure(OR=0.927,95%CI 0.861~0.997,P=0.042),serum high-sensitivity C-reactive protein(OR=1.169,95%CI 1.003~1.361,P=0.046)

关 键 词：壳多糖酶3样蛋白1 腹膜透析 血管钙化 体成分 

分 类 号：R446[医药卫生—诊断学]