血清分泌型Klotho蛋白评估维持性血液透析患者冠脉钙化程度

Serum secretory Klotho protein estimating the calcification degree of coronary artery in patients on maintenance hemodialysis

目的:观察维持性血液透析(MHD)患者血清分泌型Klotho蛋白与冠脉钙化之间的关系,探讨应用Klotho蛋白评估冠脉钙化的可行性。方法:ELISA法测定MHD患者血清分泌型Klotho蛋白水平,MSCT测定冠脉钙化积分(CACs)以评估冠脉钙化程度。Spearman相关分析了解Klotho蛋白和冠脉钙化间的关系,logistic回归分析法分析MHD患者发生冠脉钙化的危险因素。结果:共入选132例MHD患者,平均年龄(62.98±15.38)岁,中位透析龄51.00(41.25,74.25)个月。69.70%患者存在冠脉钙化,中位CACs为83.47(0,585.09),中位血清分泌型Klotho蛋白浓度为374.76(336.55,426.60)pg/m L,CACs与Klotho蛋白呈负相关(r=-0.294,P=0.001)。logistic回归分析显示,Klotho蛋白降低是MHD患者发生冠脉中、重度钙化的独立危险因素。Klotho蛋白联合传统和慢性肾脏病(CKD)相关心血管危险因素具有更强的评估MHD患者冠脉中、重度钙化的能力。结论:血清分泌型Klotho蛋白低的MHD患者具有较高发生冠脉钙化的风险,Klotho蛋白联合多个心血管危险因素可较好地评估患者冠脉中、重度钙化。

Objective： To observe the relationship between serum secretory Klotho protein and coronary artery calcification in maintenance hemodialysis（MHD） patients, and to explore the possibility of estimating calcification of coronary artery using Klotho protein. Methods： MHD patients were selected. Serum secretory Klotho protein was detected with ELISA, and multi-slice spiral CT（MSCT） was used to detect coronary artery calcification score（CACs）. Spearman correlation coefficient was used to analyze the relationship between Klotho protein and CACs. logistic regression analysis was used to determine the risk factors of calcification of coronary artery in MHD patients. Results： 132 MHD patients were recruited, their average age was 62.98±15.38 years old and the median of dialysis vintage was 51.00 months. Coronary artery calcification was detected in 69.70% patients with the median CACs of 83.47（0～585.09）. The median Klotho protein was 374.76（336.55, 426.60） pg/m L. Correlative analysis showed that Klotho protein was negatively correlated with CACs（r=-0.294, P=0.001）. logistic regression analysis showed that the risk of moderate-severe coronary artery calcification increased in association with the decreased level of Klotho protein. When Klotho protein combined with the CKD-related cardiovascular risk factors and the traditional cardiovascular risk factors, the prediction of moderate-severe coronary artery calcification became more powerful for MHD patients. Conclusion： The lower serum secretory Klotho protein is independently associated with coronary artery calcification. Serum secretory Klotho protein combined with cardiovascular risk factors may be used to predict the moderate-severe coronary artery calcification in MHD patients.