血液透析患者骨保护素细胞核因子кB受体活化因子配体与动脉僵硬度的关系

Relationship of OPG,sRANKL level and pulse wave velocity in maintenance hemodialysis patients

目的探讨血液透析患者颈-股脉搏波速度(CFPWV)和颈-桡脉搏波速度(CRPWV)的变化及与骨保护素(OPG)、细胞核因子кB受体活化因子配体(sRANKL)系统的关系。方法对北京大学人民医院血液净化中心2006年6—10月40例血液透析患者采用酶联免疫吸附法测定血清OPG、sRANKL,PWV测定仪测定外周动脉僵硬度,X线平片检测腹主动脉、股动脉及桡动脉部位血管钙化,计算血管钙化积分。结果 25例(64.1%)患者存在不同程度的血管钙化,中重度钙化者较轻度钙化者血清OPG高[(342.50±171.53)ng/L对(206.21±137.88)ng/L,P=0.025]、OPG/sRANKL比值高(454.65±455.63比135.31±136.81,P=0.035),sRANKL比较差异无统计学意义[(0.10±0.08)pmol/L对(0.12±0.08)pmol/L]。血液透析患者CRPWV及CFPWV均较对照组增高,差异有统计学意义[(9.48±1.80)m/s对(8.58±1.29)m/s,P=0.043]和[(13.42±3.26)m/s对(10.07±1.76)m/s,P<0.01]。血OPG较对照组高[(235.12±154.33)ng/L对(93.00±44.10)ng/L,P=0.01],sRANKL两组比较,差异无统计学意义[(0.12±0.08)pmol/L对(0.16±0.08)pmol/L]。相关分析发现CRPWV与舒张压、sRANKL呈正相关(r=0.389、0.349,P=0.025、0.040),控制年龄、血压因素后CRPWV仍然与sRANKL呈正相关(r=0.381,P=0.029)。多元线性回归分析显示血磷、sRANKL及钙磷乘积是CRPWV的独立影响因素,年龄是CFPWV的独立影响因素。结论血液透析患者外周动脉僵硬度增加,sRANKL独立于年龄和血压影响血液透析患者动脉僵硬度。

Objective Aortic stiffness increases end-stage renal disease all-cause and cardiovascular mortali- ty risks. We investigated arterial stiffness through the pulse wave velocity （PWV） and the roles of osteoprotegerin （OPG） and soluble receptor activator for NF-KB ligand （sRANKL） in hemodialysis patients. Methods In 40 hemodialysis patients, serum OPC/sRANKL levels and arterial stiffness were measured through ELISA and Pulse Pen tonometry ,respectively. The presence of vascular calcification were measured using plain radiographs. Results Compared with patients with slight degree vascular calcification, serum OPG levels [ （342. 50 ±171.53 ）ng/L vs （206. 21 ± 137. 88 ） ng/L, t = - 2. 253, P = 0. 025 ] and OPG/s RANKL ratio （ 454. 65 ±455.63 vs 135.31 ±136. 81, t = 59, P = 0.035 ） were significantly higher （ P 〈 0.05 ）, serum sRANKL levels [ （0. 10 ±0.08 ） pmol/L vs （0. 12 ±0. 08 ）pmol/L, t = 0. 534 ] were not significantly different in patients with severe degree vascular calcification. Compared to controls, hemodialysis patients had higher carotid-femoral [ （ 9. 48 ± 1.80 ） m/s vs （ 8.58±1.29） m/s,t =2. 073] and carotid-radial[ （13.42 ±3.26） m/s vs （ 10.07 ± 1.76） m/s,t =4. 836 ] PWV values. Serum OPG levels was significantly higher[ （235.12± 154. 33 ） ng/L vs （ 93.00 ± 44. 10 ） ng/L, t = 3.489, P = 0. 001 ] sRANKL was no significant in both groups [ （ 0. 12 ± 0. 08 ） pmol/L vs （ 0. 16 ± 0. 08 ） pmoL/L, t = - 1.410 ]. Soluble RANKL, phosphorous and product of calcium and phosphorous （or age） were independent determinants of carotid-radial （or carotid-femoral） PWV. Conclusion Arterial stillness is increased in hemodialysis patients. Serum sRANKL is an independent risk factor of increased peripheral muscular-type arterial stiffness.