尿毒症患者血清骨硬化蛋白的变化与血管钙化相关性分析

Analysis of changes of serum sclerostin in uremic patients and its correlation with vascular calcification

目的分析尿毒症患者血清骨硬化蛋白的变化情况及其与血管钙化的相关性。方法选取本院2016年3月至2018年3月收治的尿毒症患者4 5例作为观察组,并选取同期在本院接受心脏彩超、腹部侧位平片检查正常的4 5例受检者作为对照组。收集一般资料和临床指标检查,包括血钙、血磷、血镁、血清白蛋白(ALB)、总胆固醇(CHOL)、甘油三酯(TG)、低密度脂蛋白(LDL)、全段甲状旁腺激素(IPTH)和血清骨硬化蛋白水平,同时为所有入选者实施腹部X线检查,判断其血管钙化程度。结果尿毒症患者中慢性肾病多以代谢性疾病为主要原发病。观察组与对照组性别、体质量指数比较,差异无统计学意义(P>0.05);尿毒症患者ALB、TG、LDL、Ca、Mg水平低于对照组,CHOL、瓣膜钙化发生率、iPTH、P、骨硬化蛋白水平、血管钙化等级均高于对照组,差异有统计学意义(P<0.05);高龄、合并糖尿病及高血压、透析时间长均是导致尿毒症患者血清骨硬化蛋白高水平的主要原因。尿毒症患者血清骨硬化蛋白水平与年龄、iPTH、P、血管钙化分级呈负相关,与ALB、Mg水平呈正相关(P<0.05)。结论血管钙化在尿毒症患者中普遍存在且钙化等级较高,患者血清骨硬化蛋白高水平可能与血管血管钙化低等级有关,血清骨硬化蛋白可以作为新的反映尿毒症患者血管钙化程度及骨转化水平的重要指标。

Objective To analyze the changes of serum sclerostin in uremic patients and its correlation with vascular calcification. Methods Forty-five uremic patients who had been admitted to the hospital between March 2016 and March 2018 were selected as the observation group, and 45 healthy subjects after taking cardiac ultrasound and abdominal plain radiograph examination in the hospital during the same period were selected as the control group. All patients enrolled received general data investigations and examinations of clinical indicators including calcium (C a), phosphorus ( P ), magnesium (Mg), albumin (ALB), total cholesterol ( CHOL), triglyceride (TG), low density lipoprotein ( LDL), intact parathyroid hormone (IPTH), and serum sclerostin, and abdominal X-ray examination was performed on all patients to determine the degree of vascular calcification. Results The main primary disease in uremic patients in the hospital was metabolic disease. There was no significant difference between the two groups in gender and body mass index ( P < 0. 05 ). The levels of ALB, TG, LDL, HDL, Ca and Mg in the uremic patients were all lower than those in the control group.The CHOL, incidence of calcification, iPT H , P , serum sclerostin, and vascular calcification in the uremic patients were all higher than those in the control group, where the difference was statistically significant( P < 0 . 0 5 ). Older age, diabetes mellitus and hypertension, and longer dialysis time were the main causes of high levels of serum sclerostin in uremic patients. The lower the level of serum sclerostin, the higher the levels of CHOL, LDL, iPTH and P. The lower the levels of ALB, Ca and M g, the higher the degree of vascular calcification;the difference was statistically significant ( P < 0. 0 5 ). The level of serum sclerostin in uremic patients was negatively correlated with age, iPTH , P , degree of vascular calcification, and positively correlated with the level of ALB and M g( P < 0. 05 ). Conclusions V ascular calcification is prevalent and severe in patients with uremia. The high level of serum sclerostin in uremic patients might be associated with the degree of vascular calcification. Serum sclerostin may serve as a new and important indicator of vascular calcification and bone turnover in uremic patients.