维持性血液透析患者血清β-CTX、N-MID和PICP与冠状动脉钙化的关系及其诊断价值  

Relationship of serumβ-CTX,N-MID,and PICP with coronary artery calcification in maintenance hemodialysis patients and its diagnostic value

作　　者：周敏 徐阳 胡莹 黄先凤 Min Zhou;Yang Xu;Ying Hu;Xianfeng Huang(Blood Purification Center,Jingmen Hospital of Traditional Chinese Medicine,Jingmen 448001,Hubei Province,China)

机构地区：[1]荆门市中医医院血液净化中心,448001

出　　处：《中华肾病研究电子杂志》2024年第5期256-260,共5页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

基　　金：荆门市中医医院科研计划项目(2024ZYYKY022)。

摘　　要：目的探讨维持性血液透析(MHD)患者血清Ⅰ型胶原β-异构化C端肽(β-CTX)、骨钙素N端中分子片段(N-MID)和Ⅰ型前胶原羧基端前肽(PICP)与冠状动脉钙化的关系及其诊断价值。方法该研究为横断面研究,以2021年5月至2023年5月在本院进行诊治的80例MHD患者为研究对象,根据Agatston评分将其分为钙化组(47例)和无钙化组(33例)。收集患者的基本信息、合并症以及血清钙、磷、β-CTX、N-MID及PICP水平等资料。Logistic回归方法分析冠状动脉钙化的影响因素;采用受试者操作特征(ROC)曲线分析血清β-CTX、N-MID和PICP对冠状动脉钙化的诊断价值。结果与无钙化组相比,钙化组的血清磷、N-MID和PICP水平较高,而β-CTX水平较低(t=2.300、t=4.653、t=4.689、t=4.236,P均<0.05);Logistic分析显示,血清磷、β-CTX、N-MID和PICP均为MHD患者冠状动脉钙化的影响因素(OR=2.145,95%CI:1.217~3.779;OR=0.593,95%CI:0.436~0.807;OR=2.142,95%CI:1.346~3.408;OR=1.533,95%CI:1.212~1.939)。ROC曲线分析显示,β-CTX、N-MID和PICP联合诊断MHD患者冠状动脉钙化的曲线下面积(AUC)为0.951,特异度为80.0%、敏感度为83.0%。结论冠状动脉钙化的MHD患者,血清β-CTX水平显著降低,N-MID、PICP水平均显著升高,三者联合对诊断冠状动脉钙化具有一定价值。Objective To investigate the relationship ofβ-isomerized C-terminal telopeptide of type I collagen(β-CTX),N-terminal midfragment of osteocalcin(N-MID),and procollagen type I carboxyterminal propeptide(PICP)with coronary artery calcification in patients with maintenance hemodialysis(MHD)and its diagnostic value.Methods A cross-sectional study on 80 patients with MHD who underwent consultation in our hospital from May 2021 to May 2023 was conducted.They were divided into a calcification group(n=47)and a non-calcification group(n=33)according to the Agatston scoring system.The patients&apos;basic information,comorbidities,and serum levels of calcium,phosphorus,β-CTX,N-MID,and PICP were collected.The influencing factors for coronary artery calcification were analyzed by the logistic regression method.The diagnostic value of serumβ-CTX,N-MID,and PICP in coronary artery calcification was analyzed by the receiver operating characteristic(ROC)curve.Results Compared with the non-calcification group,the calcification group showed obviously higher serum levels of phosphorus(t=2.300,P<0.05),N-MID(t=4.653,P<0.05),and PICP(t=4.689,P<0.05),but significantly lower serum level ofβ-CTX(t=4.236,P<0.05).Logistic regression analysis results showed that serum phosphorus,CTX,N-MID,and PICP were all influencing factors for the coronary artery calcification in the MHD patients(OR=2.145,95%CI:1.217-3.779;OR=0.593,95%CI:0.436-0.807;OR=2.142,95%CI:1.346-3.408;OR=1.533,95%CI:1.212-1.939).ROC curve analysis showed that the area under the curve(AUC)of the combination ofβ-CTX,N-MID,and PICP was 0.951 for diagnosing the coronary artery calcification in the MHD patients,with the specificity and sensitivity being 80.0%and 83.0%,respectively.Conclusion In the MHD patients with the coronary artery calcification,serum level ofβ-CTX was significantly lower,while serum levels of N-MID and PICP were significantly higher.The combination of them three was of certain value in diagnosing coronary artery calcification in the MHD patients.

关 键 词：维持性血液透析 冠状动脉钙化 Ⅰ型胶原β-异构化C 端肽 骨钙素N 端中分子片段 Ⅰ型前胶原羧基端前肽 诊断 

分 类 号：R692.5[医药卫生—泌尿科学]