血液透析患者血浆硬骨素水平与骨转换标志物和炎性因子的相关性分析  

The correlation analysis between plasma sclerostin levels and bone turnover markers and inflammation factors in hemodialysis patients

作　　者：夏熊芳 刘峻 周春花[1] 王祺 雷容 Xia Xiongfang;Liu Jun;Zhou Chunhua;Wang Qi;Lei Rong(Department of Nephropathy and Rheumatology,Changsha Central Hospital Affiliated to Nanhua University,Changsha 410004,China)

机构地区：[1]南华大学附属长沙中心医院肾病风湿免疫科,长沙410004

出　　处：《中国医师进修杂志》2022年第10期909-913,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨血液透析患者血浆硬骨素(SOST)水平与骨转换标志物及炎性因子之间的相关性。方法选取2018年1月至2019年5月南华大学附属长沙中心医院收治的行维持性血液透析治疗的108例患者,采用酶联免疫吸附法测定入院时及透析3、6、12个月时血浆SOST水平,以SOST均值为界分为低SOST组(56例)与高SOST组(52例),比较两组血清骨转换标志物β-Ⅰ型胶原羧基端肽(β-CTX)、骨钙素(OC)、总Ⅰ型胶原氨基端延长肽(PINP)、全段甲状旁腺激素(iPTH)、N-端骨钙素(N-MID-OC)及炎性因子白细胞介素(IL)-1β、IL-6、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平,并进行腹主动脉钙化评分(ACC),采用Pearson直线相关分析血液透析患者SOST水平与骨转换标志物、炎性因子及ACC评分的关系。结果低SOST组基线(入院时)血清β-CTX、OC、PINP、iPTH、N-MID-OC水平均高于高SOST组[(976.03±205.27)ng/L比(781.34±150.45)ng/L、(175.31±50.49)ng/L比(125.75±40.17)ng/L、(321.45±82.14)μg/L比(259.41±75.36)μg/L、(345.26±102.65)ng/L比(198.52±45.71)ng/L、(19.96±5.01)μg/L比(17.41±4.23)μg/L](P<0.05);低SOST组基线血清IL-1β、IL-6、CRP、TNF-α水平及ACC均高于高SOST组[(19.31±6.01)ng/L比(15.23±4.75)ng/L、(76.85±20.34)ng/L比(57.98±15.02)ng/L、(8.15±2.36)mg/L比(7.23±1.79)mg/L、(178.37±55.52)ng/L比(157.42±10.15)ng/L、(5.96±1.78)分比(5.11±1.15)分](P<0.05)。治疗3、6、12个月,血液透析患者骨转换指标β-CTX、OC、PINP、iPTH、N-MIC-OC均上升,SOST降低,炎性因子IL-1β、IL-6、CRP、TNF-α均上升,ACC增加,差异均有统计学意义(P<0.05)。相关分析结果表明,血液透析患者SOST水平与骨转换标志物β-CTX(r=-0.465,P<0.001)、OC(r=-0.498,P<0.001)、PINP(r=-0.511,P<0.001)、iPTH(r=-0.396,P=0.012)、N-MID-OC(r=-0.323,P=0.031)及炎性因子IL-1β(r=-0.305,P=0.046)、IL-6(r=-0.318,P=0.041)、CRP(r=-0.327,P=0.034)、TNF-α(r=-0.378,P=0.024)均呈负相关,与腹主动脉钙化积分呈负相关(Objective To explore the correlation between plasma sclerostin(SOST)and bone turnover markers and inflammatory factors in hemodialysis patients.Methods One hundred and eight patients admitted to Changsha Central Hospital Affiliated to Nanhua University from January 2018 to May 2019 were selected.The levels of plasma SOST at admission and at 3,6 and 12 months of dialysis were determined by enzyme-linked immunosorbent assay.They were divided into low-SOSTgroup(56 cases)and high-SOSTgroup(52 cases)based on the mean value of SOST.The levels of serum bone turnover markersβ-Ⅰcollagen carboxy-terminal peptide(β-CTX)and osteocalcin(OC),propeptide of typeⅠprocollagen(PINP),full parathyroid hormone(iPTH),N-terminal osteocalcin(N-MID-OC),inflammatory factors interleukin-1β(IL-1β),interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)were compared between the two groups,abdominal aortic calcification(ACC)score was performed,and Pearson linear correlation analysis was used to analyze the relationship between SOST level of hemodialysis patients and bone turnover markers,inflammatory factors and ACC scores.Results The baseline levels ofβ-CTX,OC,PINP,iPTH,and N-MID-OC in the low-SOST group were higher than those in the high-SOST group:(976.03±205.27)ng/L vs.(781.34±150.45)ng/L,(175.31±50.49)ng/L vs.(125.75±40.17)ng/L,(321.45±82.14)μg/L vs.(259.41±75.36)μg/L,(345.26±102.65)ng/L vs.(198.52±45.71)ng/L,(19.96±5.01)μg/L vs.(17.41±4.23)μg/L,the differences were statistically significant(P<0.05).The baseline levels of IL-1β,IL-6,CRP,TNF-αand ACC scores in the low-SOST group were higher than those in the high-SOST group:(19.31±6.01)ng/L vs.(15.23±4.75)ng/L,(76.85±20.34)ng/L vs.(57.98±15.02)ng/L,(8.15±2.36)mg/L vs.(7.23±1.79)mg/L,(178.37±55.52)ng/L vs.(157.42±10.15)ng/L,(5.96±1.78)scores vs.(5.11±1.15)scores,the differences were statistically significant(P<0.05).After treated for 3,6 and 12 months,the levels ofβ-CTX,OC,PINP,iPTH,N-MIC-OC in hemodialysis patients were increased,the

关 键 词：血液透析滤过 炎症介导素类 硬骨素 骨转换 钙质沉着症 

分 类 号：R692.5[医药卫生—泌尿科学]