行维持性血液透析治疗终末期肾病患者血磷和骨保护素水平变化及与血管钙化的关系  

Relationships of serum phosphorus and osteophosphorin levels with vascular calcification in patients with end-stage renal disease undergoing maintenance hemodialysis

作　　者：布合力其·麦麦提[1] 刘红艳[1] 冯琦[1] 徐超 任荣[1] Buheliqi MAIMAITI;LIU Hong-yan;FENG Qi;XU Chao;REN Rong(Department of Nephrology,the Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region 83001l,China)

机构地区：[1]新疆医科大学第五附属医院肾病科,新疆维吾尔自治区乌鲁木齐830011

出　　处：《中华实用诊断与治疗杂志》2023年第5期489-493,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：新疆维吾尔自治区自然科学基金(2021D01C435)。

摘　　要：目的观察行维持性血液透析(maintenance hemodialysis,MHD)治疗的终末期肾病患者血磷和骨保护素(osteoprotegerin,OPG)水平变化及与血管钙化严重程度的关系,探讨血磷和OPG评估行MHD治疗终末期肾病患者血管钙化的价值。方法行MHD治疗终末期肾病患者150例,均行侧位腹部X线检查,采用腹主动脉钙化积分(abdominal aortic calcification score,ACCS)评估血管钙化程度,并依据ACCS分为无钙化组60例(ACCS≤4分)和钙化组90例(ACCS>4分)。比较2组入院次日血钙、血磷、OPG、C反应蛋白等实验室指标;Pearson相关法分析血磷、OPG与ACCS的相关性;多因素logistic回归分析行MHD治疗终末期肾病患者发生血管钙化的影响因素;绘制ROC曲线,评估血磷和OPG对行MHD治疗终末期肾病患者发生血管钙化的诊断效能。结果(1)钙化组年龄[(61.22±8.36)岁]大于无钙化组[(56.37±8.71)岁](t=3.423,P<0.001),透析时间[(40.35±5.77)个月]长于无钙化组[(35.22±6.15)个月](t=5.195,P<0.001),体质量指数、性别及原发病比例与无钙化组比较差异均无统计学意义(P>0.05)。(2)钙化组血钙[(2.22±0.15)mmol/L]、血磷[(1.89±0.33)mmol/L]、OPG[(13.42±2.47)ug/L]、C反应蛋白[(9.86±1.46)mg/L]水平均高于无钙化组[(2.13±0.11)mmol/L、(1.64±0.34)mmol/L、(11.27±2.84)μg/L、(7.84±1.07)mg/L](P<0.05),白蛋白、甲状旁腺激素水平与无钙化组比较差异均无统计学意义(P>0.05)。(3)血磷(r=0.807,P<0.001)、OPG(r=0.906,P<0.001)与ACCS均呈正相关。(4)血钙(β=0.254,95%CI:0.104~0.404,P=0.001)、血磷(β=0.414,95%CI:0.065~0.764,P=0.021)、OPG(β=1.104,95%CI:0.516~1.693,P<0.001)、C反应蛋白(β=8.021,95%CI:0.987~15.056,P=0.026)是行MHD治疗终末期肾病患者发生血管钙化的影响因素(P<0.05)。(5)血磷、OPG分别以1.665 mmol/L、12.08μg/L为最佳截断值,单独及联合检测诊断行MHD治疗终末期肾病患者发生血管钙化的AUC分别为0.689(95%CI:0.608~0.762,P=0.044)、0.692(95%CI:0.612~0.765,P=0.04Objective To observe the changes of blood phosphorus and osteoprotegerin(OPG)levels and their relationships with the severity of vascular calcification in patients with end-stage renal disease(ESRD)undergoing maintenance hemodialysis(MHD),and to investigate the values of blood phosphorus and OPG to the evaluation of vascular calcification in ESRD patients undergoing MHD.Methods Totally 150 ESRD patients undergoing MHD received lateral abdominal X-ray examination to assess the abdominal aortic calcification.According to the abdominal aortic calcification score(ACCS),150 patients were divided into 60 patients with ACCS≤4(non-calcification group)and 90 patients with ACCS>4(calcification group).The laboratory indexes such as blood calcium,blood phosphorus,OPG and C-reactive protein(CRP)were compared between two groups the next day after admission.Pearson correlation method was used to analyze the correlations of blood phosphorus and OPG with ACCS.Multivariate regression analysis was performed to determine the influencing factors of vascular calcification in ESRD patients undergoing MHD.ROC curves were drawn to evaluate the efficiencies of blood phosphorus and OPG on assessing vascular calcification.Results(1)The patients were older in calcification group[(61.22±8.36)years]than in non-calcification group[(56.37±8.71)years](t=3.423,P<0.001),the dialysis course was longer in calcification group[(40.35±5.77)months]than that in non-calcification group[(35.22±6.15)months](t=5.195,P<0.001),and there were no significant differences in the body mass index,gender ratio and proportion of primary diseases between two groups(P>0.05).(2)The levels of blood calcium,blood phosphorus,OPG and CRP were higher in calcification group[(2.22±0.15)mmol/L,(1.89±0.33)mmol/L,(13.42±2.47)μg/L,(9.86±1.46)mmol/L]than those in non-calcification group[(2.13±0.11)mmol/L,(1.64±0.34)mmol/L,(11.27±2.84)μg/L,(7.84±1.07)mg/L](P<0.05),and there were no significant differences in the levels of albumin and parathyroid hormone between two gro

关 键 词：终末期肾病 维持性血液透析 血管钙化 血磷 血钙 骨保护素 

分 类 号：R692.5[医药卫生—泌尿科学]