维持性血液透析患者血清巨噬细胞迁移抑制因子水平与血管钙化的关系

Relationship between serum macrophage migration inhibitory factor and vascular calcification in maintenance hemodialysis patients

目的探究维持性血液透析(maintenance hemodialysis,MHD)患者血清巨噬细胞迁移抑制因子(macrophage migration inhibitory factor,MIF)水平与血管钙化的关系。方法选取哈尔滨医科大学附属第一医院收治的98例MHD患者,分为钙化组(n=64)和非钙化组(n=34),收集受试者临床基线资料;分析血清MIF水平与腹主动脉钙化积分(abdominal aortic calcification score,AACS)、血清白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平相关性;影响MHD患者发生血管钙化的因素;血清MIF、25-羟维生素D[25-hydroxyvitamin D,25(OH)D]、血钙、血磷、全段甲状旁腺素(intact parathyroid hormone,iPTH)水平对MHD患者发生血管钙化的预测价值。结果与非钙化组比较,钙化组25(OH)D水平降低(t=15.408,P<0.001),血钙、血磷、iPTH、血清MIF、IL-6、TNF-α水平均升高(t值分别为12.098,13.384,24.570,7.255,9.694,15.567;P值分别<0.001,<0.001,<0.001,<0.001,<0.001,<0.001)。血清MIF水平与IL-6、TNF-α、AACS呈正相关(r值分别为0.666,0.693,0.501;P值分别为<0.001,<0.001,<0.001)。血清MIF、25(OH)D、血钙、血磷、iPTH水平单独检测对MHD患者发生血管钙化预测的曲线下面积分别为0.841、0.698、0.709、0.665、0.716;联合检测的AUC为0.919,诊断效能优于单一指标检测。结论血清MIF水平升高与MHD患者炎症状态及血管钙化有关,是影响MHD血管钙化发生的独立危险因素,与25(OH)D、血钙、血磷、iPTH水平联合检测可能对MHD发生血管钙化有一定预测价值。

Objective T o investigate the relationship between serum macrophage migration inhibitory factor(MIF)level and vascular calcification in maintenance hemodialysis(MHD)patients.Methods A total of 98 MHD patients admitted to the First Hospital Affiliated to Harbin Medical University were recruited.They were divided into calcification group(n=64)and non-calcification group(n=34).Their baseline clinical data were collected.The correlations between serum MIF level and abdominal aortic calcification score(AACS),serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)levels were analyzed.We also analyzed the influencing factors for vascular calcification,and the predictive values of serum MIF,25-hydroxyvitamin D(25(OH)D),calcium,phosphorus and intact parathyroid hormone(iPTH)levels for vascular calcification in MHD patients.Results In calcification group,serum 25(OH)D level decreased significantly(t=15.408,P<0.001),while serum calcium,phosphorus,iPTH,MIF,IL-6 and TNF-αlevels increased(t=12.098,13.384,24.570,7.255,9.694 and 15.567 respectively;P<0.001)as compared with those in non-calcification group.Serum MIF level was positively correlated with IL-6 and TNF-αlevels and AACS score(r=0.666,0.693,0.501;P<0.001).The areas under curves(AUCs)of serum MIF,25(OH)D,calcium,phosphorus and iPTH for the diagnosis of vascular calcification in MHD patients were 0.841,0.698,0.709,0.665 and 0.716 respectively;the AUC of integrated serum biochemical parameters was 0.919,better than the diagnostic efficiency using single serum biochemical parameter.Conclusions Serum MIF level increased significantly in MHD patients,which is related to the inflammatory state and vascular calcification,and is an independent risk factor for vascular calcification in MHD patients.Integrated estimation of serum MIF,25(OH)D,calcium,phosphorus and iPTH levels will be more useful for the prediction of vascular calcification in MHD patients.