可溶性Klotho蛋白对维持性血液透析患者血管硬化的影响

Correlation between serum soluble Klotho level and vascular sclerosis in maintenance hemodialysis patients

目的探讨维持性血液透析（maintenance hemodialysis，MHD）患者血管硬化与可溶性Klotho蛋白（serum soluble Klotho，sKL）之间的关系。方法收集60例MHD患者的临床资料，采用ELISA法检测sKL浓度。检测MHD患者踝一臂脉搏波传导速度（brachial-ankle pulse wave veloci-ty，haPWV）和颈动脉内中膜厚度（intima-media thickness，IMT），以评价MHD患者血管硬化的程度。用Logistic回归分析法分析MHD患者发生血管硬化的危险因素；用Pearson相关分析法分析sKL浓度与baPWV、IMT的相关性。结果60例MHD患者中，47例患者baPWV≥1400cm／s，血管硬化者占78．3％。根据患者血sKL水平分布范围的四分位数分为4组，I组sKL〈405ng／L，Ⅱ组sKL范围为405～624ng／L，Ⅲ组sKL范围为624～832ng／L，Ⅳ组sKL～832ng／L各组的baPWV、MaxIMT随着sKL水平的降低而升高（P〈0．01）；sKL浓度与baPWV呈负相关（r=－0．115，P〈0．01），血清sKL浓度与MaxIMT呈负相关（r=－0．224，P〈0．01），差异有统计学意义。Logistic回归分析法分析结果显示，血清sKL浓度降低（OR=2．336，95％CI1．153～7．315）和吸烟（OR=4．025，95％CI2．305～11．234）是MHD患者血管硬化的独立危险因素。结论血清sKL浓度下降与血管硬化相关，血清sKL浓度的测定可能有助于血管硬化的诊断。

Objective To determine the relationship between serum soluble Klotho （sKL） level and vascular sclerosis in maintenance hemodialysis （MHD） patients. Methods Sixty MHD patients were collected prospectively. Serum sKL was detected by ELISA. Brachial-ankle pulse wave velocity （baPWV） and carotid artery intima-media thickness （IMT） were used as criteria to determine the vas- cular sclerosis. Logistic regression analysis was used to determine the risk factor of vascular sclerosis, and Pearson correlation analysis was used to determine the relationship between sKL and baPWV or IMT. Results In the enrolled 60 MHD patients, the baPWV level above 1400 cm/s was used as a cri- terion to determine the vascular sclerosis, and 47 （78. 3%） MHD patients had vascular sclerosis. The patients were divided into four groups based on serum sKL levels： group I , sKL〈405 ng/L; group 11, 405 ng/L〈sKL〈624 ng/L; group Ⅲ, 405 ng/L〈sKL〈624 ng/L; group Ⅳ, sKL〉624 ng/L. baPWV and Max IMT were increased with the reduction of sKL levels in each group （P〈0. 01）. Ser- um sKL levels were negatively correlated to baPWV （r = -0. 115, P〈0. 01） and Max IMT （r = -0. 224, P〈0. 01）. Multivariate Logistic regression analysis revealed that lower serum sKL level （OR= 2. 336, 95% CI 1. 153 - 7. 315） and smoking （OR= 4. 025, 95% CI 2. 305 - 11. 234） were in- dependent risk factors for severe calcification of the vascular sclerosis. Conclusions The lower serum sKL is independently associated with severe vascular sclerosis. Serum sKL may have diagnostic value for severe vascular sclerosis in MHD patients.