骨保护素在血管钙化和骨质疏松关系中的重要作用

The Important Role of Osteoprotegerin in the Relationship between Vascular Calcification and Osteoporosis

目的探讨维持性血液透析患者骨密度、血管钙化和骨保护素(OPG)三者之间的关系及OPG在血管-骨对话机制中的作用。方法收集2010年5月-2012年12月行血液透析患者100例,采用X线平片检测患者血管钙化情况并评分,骨密度仪测定股骨颈骨密度,酶联免疫吸附法测定血清OPG水平,并检测患者一般生物化学指标,对各参数进行统计分析。结果 100例患者中血管钙化的检出率为74%(74/100),并且随着血管钙化程度的加重,OPG水平逐渐增高,差异有统计学意义(P<0.05)。100例患者中骨密度正常组40例,骨密度异常组60例,后者OPG水平明显高于前者,两组比较差异有统计学意义(P<0.05)。无血管钙化组的骨密度异常检出率(23.1%)明显低于血管钙化组的骨密度异常检出率(73.0%)。多重线性回归分析显示血管钙化评分、OPG水平、年龄是骨密度值的独立影响因素;透析时间、OPG水平、血白蛋白、骨密度值是血管钙化评分的独立影响因素。结论维持性血液透析患者血管钙化的同时常伴随骨质疏松,OPG在血管钙化和骨质疏松关系的发生发展过程中起了重要作用。

Objective To investigate the relationship among bone density, osteoprotegerin （OPG） and vascular calcification （VC） in maintenance hemodialysis （MHD） patients. Methods One hundred MHD patients were collected from our department between May 2010 and December 2012. The VC was detected by plain radiographs. Bone mineral density was measured with dual-energy X-ray absorptionmeter. The level of serum OPG was measured by enzyme- linked immunosorbent assay. Other clinically related indicators were also detected. The related parameters were examined statistically. Results The incidence of VC in MHD patients was 74% （74/100）, and the OPG level significantly increased with the degree of vascular calcification （P 〈 0.05）. The proportion of patients with normal bone volume was 40%, and with abnormal bone volume was 60%. Compared with patients with normal bone volume, the patients with abnormal bone volume had higher serum OPG level （P 〈 0.05）. The patients with no VC had a lower incidence of abnormal bone volume than patients with VC （P 〈 0.05）. Multiple linear regression analysis revealed that vascular calcification score, OPG level and age were independent factors for bone mineral density. Dialysis time, OPG level, serum albumin level and bone mineral density were independent factors for vascular calcification score. Conclusions The MHD patients with vascular calcification are often associated with osteoporosis at the same time. OPG plays an important role in the relationship between vascular calcification and osteoporosis.