维持性血液透析患者胎球蛋白A和炎症水平与心脏瓣膜钙化的相关性

Association of Fetuin-A and inflammation levels with cardiac calcification in maintenance hemodialysis patients

目的探讨继发性甲状旁腺功能亢进患者行甲状旁腺全切除或次全切除术的预后。方法入选2009年1月至2014年3月前在青岛大学附属医院血液透析中心的维持性血液透析（maintenance hemodialysis，MHD）患者99例，所有患者均行超声心动检查，根据超声心动结果将患者分为合并心脏瓣膜钙化组和无心脏瓣膜钙化组，另根据心脏瓣膜钙化数量将患者分为无瓣膜钙化（A组）、单个瓣膜钙化（B组）和双瓣膜钙化（C组）。采用酶联免疫吸附法（ELISA）检测血胎球蛋白A（Fetuin-A）、白细胞介素6（interleukin-6，IL-6）、超敏C反应蛋白（high sensitivity C-reactive protein，hs—CRP）水平并评价上述指标与心脏瓣膜钙化的相关性。结果99例患者中合并瓣膜钙化40例（占40．4％），其中二尖瓣瓣膜钙化（mitral valve calcification，MVC）27例（占27．3％），主动脉瓣瓣膜钙化（aortic valve calcification，AVC）30例（占30．3％），二尖瓣瓣膜合并主动脉瓣瓣膜钙化（MVC合并AVC）17例（占17．2％）。比较合并瓣膜钙化组和无瓣膜钙化组患者的临床资料发现，合并瓣膜钙化组的年龄、透析时间、血磷、全段甲状旁腺素（intact parathyroid hormone，iPTH）、hs-CRP、IL-6更高，白蛋白、Fetuin-A水平更低。比较A组、B组和C组发现，随着年龄、透析时间的增高，血磷、钙磷乘积、1I．-6、hs-CRP水平的增高，瓣膜钙化的数量逐渐增多，而随着血白蛋白、Fetuin-A水平的增高，瓣膜钙化的数量逐渐减少。以Fetuin-A为自变量行相关性分析发现，与年龄（r=-0．246，P=0．014）、透析时间（r=-0．297，P=0．003）、iPTH（r=-0．256，P=0．011）、hs—CRP（r=-0．272，P=0．006）、IL-6（r=-0．492，P=0．000）、心脏瓣膜钙化（r=-0．6，P=0．001）呈负相关，而与血白蛋白（r=0．298，P=0．003）呈正相关。结论MHD患者心脏瓣膜钙化的发生率较高，以主动脉瓣瓣膜钙化多见。Fetuin-A、炎症水平与心脏瓣膜钙化有着重要的相关性，评估Fetuin-A、炎症水平可能对识别心血管事件特别是心脏瓣膜钙化的发展和恶化有重要价值。

Objective To explore the importance of nontraditional risk factors for cardiac valve calcification in maintenance hemodialysis（MHD） patients. Methods Ninety-nine patients（53 males, and 46 females） subject to MHD for at least 6 months in the Blood Purification Center of the affiliated hospital of Qingdao University before March 2014, aged over 18 years were enrolled in this study. Echocardiography was used to detect the calcification. Patients were divided into two groups based on the echocardiographic findings, one as valve calcification group, and the other as valve non-calcification group. In addition, patients were separated into three groups based on the number of valve calcifica- tion： group A as zero valve calcification, group B as one valve calcification and group C as two valves calcification. Fetuin-A, IL-6 and hs-CRP were measured by ELISA. Results In the 99 patients, cardiac valve calcification was found in 40 patients （40. 4%）, in which aortic valve calcification was found in 30 patients（30. 3%）, mitral valve calcification in 27 patients （27. 3%）, and both aortic and mitral valves calcification in 17 patients （17. 2%）. Patients with valve calcification had older age, longer dialysis duration, higher serum phosphate and higher levels of intact parathyroid hormone, hs-CRP and IL-6, lower levels of albumin and Fetuin-A than those of the patients without valve calcification. Pa- tienvs age, dialysis duration, serum phosphate, calcium phosphorus product（Ca × p）, and the levels of IL-6 and hs-CRP were increased with the number of valves calcified, and serum albumin and Fetuin- A levels were decreased with the number of valves calcified. Serum Fetuin-A levels were negatively correlated with age （r = - 0. 246, P = 0. 014）, dialysis duration （r = - 0. 297, P = 0. 003）, parathy- roid hormone levels （r = - 0. 256, P = 0. 011）, serum IL-6 levels （r = - 0. 492, P = 0. 000）, serum hs-CRP levels （r = - 0. 272, P = 0. 006） and valvular calcification （r = - 0. 600, P = 0. 001 ）. Howev- er, serum fetuin-A levels were positively correlated with serum albumin （r = 0. 298, P = 0. 003）. Conclusions Cardiac valve calcification is prevalent in MHD patients, especially aortic valve calcifica- tion. Serum fetuin-A showed an important association with valvular calcification and inflammation in MHD patients. Assessment of both serum levels of fetuin-A and inflammation may be of value to iden- tify those subjects at higher risk of development and progression of cardiovascular events especially cardiac calcification.