骨唾液酸蛋白与维持性血液透析患者腹主动脉钙化的关系

Between bone sialoprotein and abdominal aortic calcification in maintenance hemodialysis patients

目的:探讨血清骨唾液酸蛋白(BSP)与维持性血液透析(MHD)患者腹主动脉钙化的关系。方法:选取2016年5月至2017年2月于本院血液净化中心规律透析患者75例。检测患者血清BSP,并进行腹部侧位X平片拍摄,根据kauppila半定量积分方法进行腹主动脉钙化评分(AACs),参考CORD分段方法,根据AAC得分将患者分为无或轻度钙化组(AACs≤4)、中度钙化组(5≤AACs≤15)和重度钙化组(AACs≥16)。Logistic回归分析MHD患者AAC的影响因素。受试者工作特征(ROC)曲线分析BSP对血管钙化的诊断价值。结果:75例MHD患者中发生腹主动脉钙化者56例(74.67%),AACs中位数为4(0,24)分,血清BSP中位数为20.12(18.63,24.21)ng/ml。中度钙化组、重度钙化组BSP水平均高于无或轻度钙化组[22.43(19.58,6.84)ng/ml、21.99(19.87,26.18)ng/ml vs 19.16(17.3,23.3)ng/ml,P<0.05]。Logistic回归分析发现BSP是AAC的独立危险因素(OR=1.175,95%CI 1.004~1.375,P<0.05)。ROC曲线分析发现,BSP诊断AAC的曲线下面积为0.718(95%CI为0.604~0.833,P=0.001),BSP诊断AAC的临界值为21.51 ng/ml,灵敏度为0.711,特异度为0.595。结论:血清BSP水平和MHD患者AAC的严重程度相关,高水平的BSP是AAC的独立危险因素。BSP对MHD患者腹主动脉钙化具有潜在诊断价值。

Objective： To evaluate the potential association of bone sialoprotein with the development of abdominal aortic calcification（ AAC） in maintenance hemodialysis（ MHD） patients. Methodology： Seventy-five patients who were on MHD between May 2016 and Feb 2017 in the dialysis center were enrolled.Serum bone sialoprotein was tested.AAC was measured by abdomen lateral plain.Kauppila score was used to assess the degree of CAC. Referring to CORD segmentation method,patients was divided into three groups： no or mild calcification group（ AACs≤4）,moderate calcification group（ 5≤AACs≤15） and severe group（ AACs≥16）. Logistic regression analysis was used to determine the risk factor of AAC in MHD patients.The diagnostic value of serum bone sialoprotein for AAC was assessed using receiver operator characteristic（ ROC） curve. Results： AAC was present in 74. 67%（ 56/75） patients,the median AAC score was 4（ 0,24）.The median of serum bone sialoprotein was 20. 12（ 18. 63,24. 21） ng/ml. The serum bone sialoprotein levels were significantly elevated in moderate and severe calcification group compared to no or mild calcification group[22. 43（ 19. 58,26. 84） ng/ml and21. 99（ 19. 87,26. 18） ng/ml vs 19. 16（ 17. 3,23. 3） ng/ml,p〈0. 05]. Multivariate logistic regression analysis showed that serum bone sialoprotein level was independent risk factor for AAC（ OR = 1. 175,95%CI 1. 004 ~ 1. 375,P0. 05）.The area under the ROC curve of serum bone sialoprotein for AAC was 0. 718（ 95% CI 0. 604 ~ 0. 833,P = 0. 001）,sensitivity was0. 711,and specificity was 0. 595 for a cutoff value of 21. 51 ng/mL. Conclusion： Serum bone sialoprotein level is associated with AAC.Serum bone sialoprotein level may have a diagnostic value for AAC in MHD patients.