钙蛋白颗粒与慢性肾脏病G3~5D期患者冠状动脉钙化的相关性研究  

The correlation between calciprotein particles and coronary calcification in patients with chronic kidney disease at G3~5D stage

作　　者：陈雨柔 王书婷 廖晟淳 叶朝阳 CHEN Yu-rou;WANG Shu-ting;LIAO Cheng-chun;YE Chaoyang(Department of Nephrology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine;TCM Institute of Kidney Disease,Shanghai University of Traditional Chinese Medicine;Key Laboratory of Liver and Kidney Diseases(Shanghai University of Traditional Chinese Medicine),Ministry of Education;Shanghai Key Laboratory of Traditional Chinese Clinical Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院肾病科,上海201203 [2]上海中医药大学中医肾病研究所 [3]肝肾疾病病证教育部重点实验室(上海中医药大学) [4]上海市中医临床重点实验室

出　　处：《中国血液净化》2024年第1期35-40,共6页Chinese Journal of Blood Purification

基　　金：国家自然科学基金面上项目(82174289);华东片区及市级中医专科专病联盟建设项目-肾水病中医专病联盟建设[ZY(2021-2023)-0302];上海市卫生健康委员会科研项目(2014Y0382)。

摘　　要：目的分析钙蛋白颗粒(calciprotein particles,CPPs)与慢性肾脏病(chronic kidney disease,CKD)G3~5D期冠状动脉钙化的相关性,探讨CPPs分别对于血液透析(hemodialysis,HD)和非HD患者冠状动脉钙化的预测价值以及影响因素。方法本研究采用单中心、横断面调查方法纳入CKD G3~5D患者75例,根据CKD分期分层、冠状动脉钙化积分(coronary artery calcification score,CACS)分组,将患者分为钙化组和无钙化组,比较CKD各期2组间CPPs的差异。应用二元Logistics回归分析CKD G3~5期(非透析)冠状动脉钙化的危险/保护因子。Kruskal-Wallis检验和Pearson卡方检验评估CPPs与HD冠状动脉钙化严重程度的关系。应用单因素线性回归分析CKD G3~5D期冠状动脉钙化人群CPPs的影响因素。结果二元Logistics回归分析结果显示CPPs(每SD增加)是CKD G3~5期(非透析)冠状动脉钙化的独立保护因素,CPPs浓度每增加1个SD(10.20)与冠状动脉钙化风险降低73.4%相关(OR=0.266,95%CI:0.077~0.916,P=0.036)。Kruskal-Wallis检验结果显示CPPs随着冠状动脉钙化严重程度升高(H=6.557,P=0.037),同时CACS水平随着CPPs增多而升高(H=7.440,P=0.024)。Pearson卡方检验结果显示相比于低水平CPPs组,中、高水平CPPs组高度冠状动脉钙化的HD人群(CACS>100)占比更大,3组之间不同钙化严重程度的人群比例差异具有统计学意义(χ^(2)=9.800,P=0.044)。单因素线性回归分析结果显示在CKD G3~5D期冠状动脉钙化患者中,CPPs与eGFR-EPI呈负相关(β=-0.424,P=0.004),与血肌酐(β=0.453,P<0.001)、血钙(β=0.328,P=0.014)呈正相关。结论CPPs是CKD G3~5期(非透析)患者冠状动脉钙化的保护因子,与之相反,对于HD患者,CPPs越高提示冠状动脉钙化严重程度越高。eGFR-EPI、血肌酐、血钙可能是是CKD G3~5D期冠状动脉钙化患者CPPs变化的影响因素。Objectives To analyze the correlation between calciprotein particles(CPPs)and coronary calcification in chronic kidney disease(CKD)G3~5D patients,and to discuss the predictive value and influencing factors of CPPs for coronary calcification in both hemodialysis(HD)and non-HD patients.Method This single-centered and cross-sectional survey study enrolled 75 CKD G3~5D patients.Based on CKD stage and coronary artery calcification score(CACS),the patients were divided into calcification group and non-calcification group to compare the differences of CPPs at different CKD stages between the two groups.The risk and protective factors for calcification in CKD G3~5(non-dialysis)patients were assessed using bivariate logistic regression.The correlation between CPPs and degrees of coronary calcification in HD patients was evaluated using Kruskal-Wallis test and Pearson chi square test.The influencing factors for CPPs in CKD G3~5D patients with calcification were investigated using univariate linear regression.Result For CKD G3~5(non-dialysis)patients,bivariate logistic regression showed that CPPs(increased per SD)were the independent protective factors for coronary calcification;an increase of one SD(10.20)of CPPs was associated with a 73.4%reduction in coronary calcification risk(OR:0.266,95%CI:0.077~0.916,P=0.036).Kruskal-Wallis test showed that CPPs increased with the increase of CACS(H=6.557,P=0.037),and CACS increased with the increase of CPPs(H=7.440,P=0.024).Pearson chi square test demonstrated that the proportion of HD patients with CACS>100 was more in the middle and high CPPs groups than that in the low CPPs group,and the ratios of calcification degrees were statistically different among the 3 CPPs groups(χ^(2)=9.800,P=0.044).Univariate linear regression showed a negative correlation between CPPs and eGFR-EPI(β=-0.424,P=0.004)and positive correlations between CPPs and serum levels of Scr(β=0.453,P<0.001)and calcium(β=0.328,P=0.014)in CKD G3~5D patients with coronary calcification.Conclusion In CKD G3~5(non-dia

关 键 词：钙蛋白颗粒 慢性肾脏病 冠状动脉钙化 

分 类 号：R692.5[医药卫生—泌尿科学]