维持性血液透析患者心脏瓣膜钙化与sclerostin之间的关系

The Relationship between sclerostin and vascular calcification in maintenance hemodialysis patients

目的观察维持性血液透析(maintenance hemodialysis,MHD)患者心脏瓣膜钙化情况,分析血清sclerostin水平与心脏瓣膜钙化之间的相关性。方法选取河北医科大学第二医院进行MHD的50例患者为试验组,选取35例健康人为对照组,收集临床资料,用酶联免疫吸附实验(ELISA)试剂盒测定血清sclerostin水平,用心脏彩色超声对心脏瓣膜钙化进行评估,并对结果进行相关分析。结果试验组与对照组的心脏瓣膜钙化有明显差异(40%vs 8.57%,P <0.05)。血清sclerostin水平与全段甲状旁腺激素(iPTH)(r=-0.283,P=0.046)、碱性磷酸酶(ALP)呈负相关(r=-0.407,P=0.003),与心脏瓣膜钙化的发生率呈正相关(r=0.408,P=0.046)。无瓣膜钙化患者较有瓣膜钙化患者年龄[47.5(33.8~62.3)岁vs 69.5(56.5~77.5)岁]与血清sclerostin水平[5.66(4.39~8.09)ng/ml vs 8.28(6.40~12.37)ng/ml]更低,血磷(P)水平[(2.14±0.55)mmol/L vs(1.81±0.56)mmol/L)更高,差异有统计学意义(P <0.05)。年龄和血清sclerostin水平是心脏瓣膜钙化的独立危险因素,OR值分别是6.794,95%CI=1.474~31.318(P=0.014);6.74,95%CI=1.613~28.157(P=0.021)。血清sclerostin较低组的iPTH和ALP水平明显高于血清sclerostin较高组[252(168~524.5)pg/ml vs 139(59.5~343)pg/ml和78.0(63.6~81.0)U/L vs62.0(59.0~69.0)U/L],差异有统计学意义(P <0.05)。另外,血清sclerostin较高组腹主动脉钙化和心脏瓣膜钙化的发生率均高于血清sclerostin较低组(84%vs 44%和60%vs 20%),差异有统计学意义(P <0.05)。结论 MHD患者心脏瓣膜钙化发生率高,心脏瓣膜钙化患者的sclerostin升高,年龄和sclerostin是心脏瓣膜钙化的危险因素。sclerostin可能作为MHD患者血管钙化的新的生物学标记物应用于临床。

Objective To observe the calcification of cardiac valves in patients undergoing maintenance hemodialysis （MHD）, to investigate the factors affecting sclerostin and analyze the correlations between sclerostin and valves calcifications.Methods A total of 50 patients undergoing MHD at the Second Hospital of Hebei Medical University were selected as experiment group subjects, and 35 healthy persons were selected as the control group. Clinical data were collected, and ELISA were applied to measure the serum sclerostin level and cardiac doppler ultrasound were used to assess the calcification of cardiac valves. The correlation analysis was applied to the results.Results Significant difference on cardiac valves calcification was observed between experimental and control groups （40% vs 8.6% , P 〈 0.05 ）. The serum sclerostin level was negatively correlated to intact parathyroid hormone（iPTH）（ r = -0.283 , P = 0.046 ） and alkaline phosphatase（ r = -0.407 , P = 0.003 ）, positively correlated to the rate of cardiac valves calcifications （ r = 0.408 , P = 0.046 ）.The average age of patients with and without valves calcification is 47.5 （ 33.8 - 62.3 ） vs 69.5 （ 56.5 - 77.5 ）. Serum sclerostin level are lower in patients without valves calcification than that of patients with valves calcification [ 5.66 （ 4.39 -8.09） ng/ml vs 8.28 （ 6.40 - 12.37 ） ng/ml], while the serum phosphate level is higher（ 2.14 ± 0.55 mmol/L vs 1.81 ± 0.56 mmol/L）, the difference is statistically significant. The age and serum sclerostin level are the independent risk factors of cardiac valves calcification, OR values are 6.794 ,95% CI = 1.474 - 31.318 （ P = 0.014 ）; 6.74 ,95% CI = 1.613 - 28.157 （ P = 0.021 ）, respectively. The iPTH and ALP level are significantly higher in group with lower sclerostin level, 252（168- 524.5 ） pg/ml vs 139（ 59.5 -343） pg/ml and 78.0 （ 63.6 - 81.0 ） U/L vs 62.0 （ 59.0 - 69.0 ）U/L,the difference is statistically significant （ P 〈 0.05 ）. For calcification, the rate of abdominal aortic valve and cardiac valve calcification is higher in patients with higher serum sclerostin level, （84% vs 44% and 60% vs 20%）. The difference is statistically significant （ P 〈 0.05 ）.Conclusion The rate of vascular calcification is higher in MHD patients, and cardiac valve calcification is positively correlated to serum sclerostin level. Both age and serum sclerostin level are risk factors of cardiac valve calcification. Sclerostin can be used as a new biomarker for vascular calcification in MHD patients.