慢性肾脏病5期患者sclerostin与桡动脉钙化的关系

Sclerostin and radial artery calcification in chronic kidney disease stage 5 patients

目的探讨慢性肾脏病5期患者桡动脉及血清sclerostin表达情况,以及sclerostin与桡动脉钙化的关系。方法取52例初次行动静脉内瘘桡动脉-头静脉端端吻合术患者的桡动脉标本,硝酸银染色(von Kossa法)观察桡动脉钙化情况,免疫组织化学法观察桡动脉sclerostin表达情况。收集患者基本资料及动静脉内瘘术前清晨空腹静脉血,测定血红蛋白(Hb)、血尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、钙(Ca)、磷(P)、碱性磷酸酶(AKP)、白蛋白(Alb)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)以及全段甲状旁腺激素(iPTH)浓度;用酶联免疫吸附测定(ELISA)方法检测患者血清sclerostin水平。根据桡动脉钙化与免疫组织化学结果,将患者分为非钙化组和钙化组,以及染色阴性组和染色阳性组,比较组间临床指标差异,并行logistic回归分析明确血管钙化与染色阳性危险因素。同时,将患者血清sclerostin水平与临床资料行相关性分析。结果钙盐染色阳性的20例患者桡动脉均有sclerostin阳性表达,钙盐染色阴性的32例患者桡动脉中有10例(31.3%)存在sclerostin阳性表达。桡动脉钙化及sclerostin免疫组织化学阳性表达患者年龄、血清AKP及sclerostin水平均高于非钙化及sclerostin阴性表达组(P<0.05)。多因素logistic回归分析结果显示年龄和血清sclerostin水平是桡动脉钙化的主要危险因素(P<0.05),而血清sclerostin水平是桡动脉表达sclerostin的唯一相关因素(P<0.01)。结论 Sclerostin参与慢性肾脏病5期患者桡动脉钙化的过程。骨-血管轴可能通过sclerostin相互调控血管钙化。

Objective To investigate the levels of the serum sclerostin and expressions of sclerostin in radial arteries,and to explore the association of sclerostin and radial artery calcification in patients with chronic kidney disease stage 5.Methods A total of 52 patients who did arteriovenous fistula operations for the first time were enrolled in the study.The segments of radial arteries were obtained during operations and evaluated by von Kossa and immunohistochemistry staining.Blood samples and baseline characteristics of the study cohort were collected.Serum hemoglobin,blood urea nitrogen,creatinine,uric acid,calcium,phosphorus,alkaline phosphorus,albumin,total cholesterol,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol,C-reactive protein and intact parathyroid were tested.Serum sclerostin was measured using the quantitative ELISA method.The patients were divided into non-calcification and calcification groups,sclerostin positive expression and negative expression groups.The difference of clinical data between the two groups were compared.The logistic regression models and correlation analysis were used to test the association between radial artery calcification,sclerostin and clinical data. Results Among 52 patients,20 cases showed radial artery calcification,and all of them showed sclerostin positive expression.Moreover,10 patients without calcification（31.3%）showed sclerostin positive expression.Compared with non-calcification group and sclerostin negative expression group,age,serum alkaline phosphatase and sclerostin were much higher in radial artery calcification group and sclerostin positive expression group （P 〈0.05 ）.Older age and higher serum sclerostin level were associated with radial artery calcification （P 〈 0.05 ）.Meanwhile,higher serum sclerostin level was the only factor correlated with vascular sclerostin positive expression （P 〈0.01 ）.Conclusion These data support a strong relationship between sclerostin and radial artery calcification.Sclerostin may be a novel candidate for the bone-vascular axis in chronic kidney disease stage 5 patients.