维持性血液透析患者血管钙化和血清骨硬化蛋白的相关因素

Correlation between vascular calcification and serum sclerostin in maintenance hemodialysis patients

目的探讨维持性血液透析(MHD)患者血清骨硬化蛋白与慢性肾脏病矿物质和骨异常(CKD-MBD)相关指标尤其是血管钙化的关系。方法筛选暨南大学附属第一医院MHD患者72例,收集一般资料,检测血钙、磷、甲状旁腺激素(IPTH)等矿物质代谢指标,透析前后肌酐、尿素,计算Kt/V。用酶联免疫吸附法检测血清骨硬化蛋白水平。行腰椎侧位片进行腹主动脉钙化评分(Kauppila半定量法)。按血清骨硬化蛋白水平(≤125 pg/mL和> 125 pg/mL)分为2组,比较分析CKD-MBD相关指标与骨硬化蛋白的关系,并对其进行多因素Logistic回归分析。结果低血清骨硬化蛋白组和高血清骨硬化蛋白组比较发现,MHD患者IPTH差异统计学意义(P <0.05)。将CKD-MBD等相关指标引入Logistic回归模型发现,透析龄、男性和无尿是MHD患者血清骨硬化蛋白的独立危险因素,IPTH和Kt/V是其保护因素。结论透析龄、男性和无尿是MHD患者血清骨硬化蛋白的独立危险因素,IPTH和Kt/V是其保护因素。腹主动脉钙化与血清骨硬化蛋白无关。

Objective To investigate the correlation between serum sclerostinlevel and chronic kidney dis-ease-mineral and bone disorder(CKD-MBD)-related vascular calcification in maintenance hemodialysis(MHD)patients.Methods This was a cross-sectional study,a total of 72 MHD patients were enrolled from the first affiliated hospital of Jinan university.The biochemical indicators of mineral metabolism and serum sclerostin level were de-tected by ELISA.The abdominal aorta calcification score(AACS)was assessed according to Kauppila method on lateral spine imaging by using DEXA assay.Patients were divided into two groups according to the median level of serum sclerostin:the low sclerostin group(≤125 pg/mL)and the high sclerostin group(>125 pg/mL).Association of serum sclerostin level and the indicators of CKD-MBD was analyzed.Results Significant difference in intact parathyroid hormone(IPTH)between the high sclerostin group and the low sclerostin group was observed.Multivar-iate Logistic regression analysis demonstrated that dialysis duration,male and anuria were independent risk factors-forthe high sclerostin level,but IPTH and Kt/V were protective factors.Conclusion Dialysis duration,man andanuria were independent risk factors,and IPTH and Kt/V were protective factors for the high serum sclerostin level in MHD patients.There was no correlation between abdominal aorta calcification and serum sclerostin level.