维持性血液透析患者血清骨硬化蛋白水平与矿物质代谢及骨密度的相关性

Association of serum sclerostin level with mineral disorder and bone density in patients on maintenance hemodialysis

目的探讨维持性血液透析（MHD）患者血清骨硬化蛋白（Sclerostin）水平与矿物质代谢紊乱、骨病变和腹主动脉钙化的相关关系。方法病例来自上海交通大学医学院附属仁济医院的维持性血液透析患者175例，酶联免疫吸附法（ELISA）检测血清Sclerostin水平；超声定量法检测跟骨骨密度（BMD）；腹部侧位平片检查腹主动脉钙化。收集患者的临床资料和血生化指标，分析血清Sclerostin水平与MHD患者矿物质代谢紊乱、骨病变和腹主动脉钙化的相关关系。结果175例患者血清Sclerostin中位数为160．50（100．67，256．39）pmol/L。单因素相关分析显示，血清Sclerostin水平与年龄、体质量指数（BMI）、血钙、25（OH）维生素D呈正相关，与单室尿素清除指数（spKt／v）、全段甲状旁腺素（iPTH）呈负相关（均P〈0．05）。逐步多元线性回归分析显示性别、年龄、BMI与1g[Sclerostin]呈正相关，lg[iPTH]与lg[Sclerostin]呈负相关。骨密度正常（T值≥-1s）组患者的Sclerostin水平显著高于骨密度低下（T值〈-1s）组患者[201．13（107．40，327．84）pmol／L比142．97（99．52，226．02）pmol／L，P=0．0351。单因素相关分析显示MHD患者血清Sclerostin水平与跟骨BMD呈正相关（r=0．227，P=0．003）。Logistic回归分析显示Sclerostin水平与发生骨密度低下风险呈负相关[OR=0．241，95％C／（0．078，0．749），P=0．014]。Sclerostin水平与腹主动脉钙化评分无明显相关。结论MHD患者血清Sclerostin水平与iPTH水平呈负相关，与跟骨骨密度呈正相关，与腹主动脉钙化无相关。Sclerostin有可能成为反映MHD患者骨转化水平的标志物。

Objective To explore the relationship between serum sclerostin level, and mineral metabolism, bone density, abdominal aortic calcification in maintenance hemodialysis （MHD） patients. Methods Serum sclerostin levels from 175 cases of MHD patients were measured by ELISA. Caleaneus bone mineral density （BMD） was measured by quantitative ultrasound （QUS）. The abdominal aortic calcification was detected by abdomen lateral plain radiographs. Interrelations among above parameters were examined statistically. Results The median sclerostin concentration of 175 patients was 160.50（100.67, 256.39） pmol/L. Serum selerostin levels were correlated positively with age, BMI, serum calcium and serum 25（OH）-vitamin D, while negatively with spKt/v and serum iPTH. In multiple regression analysis, serum sclerostin levels were associated significantly and independently with age, sex, BMI and serum iPTH. Compared to patients with normal BMD （T score≥-1s）, the patients with low BMD （T score〈-1s） had lower serum sclerostin level [142.97（99.52, 226.02） vs 201.13（107.40, 327.84） pmol/L, P=0.035]. Serum sclerostin levels were correlated significantly and positively with calcaneus BMD. Multivariate logistic regression analysis showed that serum sclerostin level was an independent protective factor for low BMD in MHD patients[OR=0.241, 95% CI （0.078, 0.749）, P= 0.014]. Conclusions Serum sclerostin levels are associated with mineral disorder and bone density. Sclerostin may become a promising marker of bone turnover in MHD patients.