血清Apelin和补体C1q肿瘤坏死因子相关蛋白9与糖尿病肾病慢性肾脏病Ⅴ期患者血管钙化的关系

Relationships of serum apelin and CTRP9 with vascular calcification in patients with diabetic nephropathy chronic kidney disease stage-Ⅴ

目的探讨糖尿病肾病慢性肾脏病Ⅴ期(chronic kidney disease-Ⅴ, CKD-Ⅴ)患者血清Apelin、补体C1q肿瘤坏死因子相关蛋白9(complement C1q tumor necrosis factor related protein 9, CTRP9)水平与血管钙化的关系。方法糖尿病肾病CKD-Ⅴ期患者139例,根据腹主动脉钙化评分分为钙化组67例和非钙化组72例。比较2组一般资料,血清Apelin、CTRP9、白蛋白、肌酐、胆固醇、三酰甘油、25-羟维生素D3、甲状旁腺激素、血钙、血磷、血红蛋白水平以及预估肾小球滤过率、尿蛋白肌酐比值;多因素logistic回归分析糖尿病肾病CKD-Ⅴ期患者血管钙化的影响因素;绘制ROC曲线评价血清Apelin和CTRP9诊断糖尿病肾病CKD-Ⅴ期患者血管钙化的价值。结果钙化组血清Apelin[(57.62±4.91)μg/L]、CTRP9[(7.81±0.90)μg/L]水平低于非钙化组[(91.32±7.11)、(10.62±1.81)μg/L],年龄[(68.40±8.90)岁]、血磷[(2.31±1.20)mmol/L]、25-羟维生素D3[(24.88±6.21)μg/L]和甲状旁腺激素[(469.13±98.31)ng/L]水平高于非钙化组[(62.10±6.20)岁、(1.91±0.90)mmol/L、(21.72±4.51)μg/L、(412.62±67.22) ng/L](P<0.05);2组性别比例、血压、体质量指数和白蛋白、肌酐、胆固醇、三酰甘油、血钙、血红蛋白水平以及估算肾小球滤过率、尿蛋白肌酐比值比较差异均无统计学意义(P>0.05)。多因素logistic回归分析结果显示,年龄≥65岁(OR=1.864,95%CI:1.079~3.220,P=0.025)、甲状旁腺激素水平≥440 ng/L(OR=2.289,95%CI:1.484~3.532,P<0.001)是糖尿病肾病CKD-Ⅴ期患者发生血管钙化的独立危险因素,血清Apelin≥75μg/L (OR=0.817,95%CI:0.705~0.947,P=0.007)、CTRP9≥9μg/L(OR=0.901,95%CI:0.831~0.976,P=0.011)是其保护因素。血清Apelin、CTRP9分别以60μg/L、8μg/L为最佳截断值,诊断糖尿病肾病CKD-Ⅴ期患者血管钙化的AUC分别为0.816(95%CI0.751~0.874,P<0.001)、0.824(95%CI:0.762~0.893,P<0.001),灵敏度分别为76.7%、82.1%,特异度分别为81.2%、77.5%。结论糖尿病肾病CKD-Ⅴ期血管钙化患者血清Apelin、CTRP9水平降低,是糖尿病肾病CKD-Ⅴ期患者发生血管钙化的危险因素。

Objective To investigate the relationships of serum apelin and complement C1 q tumor necrosis factor related protein 9(CTRP9) levels with vascular calcification in patients with diabetic nephropathy chronic kidney disease stage-Ⅴ(CKD-Ⅴ). Methods Totally 139 patients with diabetic nephropathy CKD-Ⅴ were divided into calcification group(n=67) and non-calcification group(n=72) according to the abdominal aortic calcification score. The general data, serum apelin, CTRP9, albumin, creatinine, cholesterol, triacylglycerol, 25-hydroxyvitamin D3, parathyroid hormone, blood calcium, blood phosphorus, hemoglobin, estimated glomerular filtration rate and urinary protein creatinine ratio were compared between two groups. The influencing factors for vascular calcification were analyzed by multivariate logistic regression, and ROC was drawn to evaluate the values of serum apelin and CTRP9 to the diagnosis of vascular calcification in diabetic nephropathy patients with CKD-Ⅴ. Results The levels of serum apelin and CTRP9 were lower in calcification group((57.62±4.91),(7.81±0.90) μg/L) than those in non-calcification group((91.32±7.11),(10.62±1.81) μg/L)(P<0.05). The patients were older in calcification group((68.4±8.9) years) than those in non-calcification group((62.1±6.2) years)(P<0.05). The levels of blood phosphorus, 25-hydroxyvitamin D3 and parathyroid hormone were higher in calcification group((2.31±1.20) mmol/L,(24.88±6.21) μg/L,(469.13± 98.31)ng/L)than those in non-calcification group((1.91±0.90)mmol/L,(21.72±4.51)μg/L,(412.62±67.22)ng/L)(P<0.05).There were no significant differences in sex ratio,blood pressure,body mass index,albumin,creatinine,cholesterol,triacylglycerol,blood calcium,hemoglobin,estimated glomerular filtration rate and urinary protein creatinine ratio between two groups(P>0.05).Multivariate logistic regression analysis results showed that age≥65 years(OR=1.864,95%CI:1.079-3.220,P=0.025)and parathyroid hormone≥440 ng/L(OR=2.289,95%CI:1.484-3.532,P<0.001)were the independent risk factors,while serum apelin ≥75μg/L(OR=0.817,95%CI:0.705-0.947,P=0.007)and CTRP9 ≥9μg/L(OR=0.901,95%CI:0.831-0.976,P=0.011)were the protective factors for vascular calcification in patients with diabetic nephropathy CKD-Ⅴ.When the optimal cut-offvalues of apelin and CTRP9 were 60μg/L and 8μg/L,the AUCsfor vascular calcification were 0.816(95%CI:0.751-0.874,P<0.001)and 0.824(95%CI:0.762-0.893,P<0.001),with the sensitivities of 76.7%and 82.1%and the specificities of 81.2%and 77.5%,respectively.Conclusion The levels of serum apelin and CTRP9 decrease in patients with diabetic nephropathy CKD-Ⅴ complicated with vascular calcification,and both of them are the risk factors for vascular calcification in patients with diabetic nephropathy CKD-Ⅴ.