终末期肾病病人骨桥蛋白水平与冠状动脉钙化相关性

RELATIONSHIP BETWEEN OSTEOPONTIN LEVEL AND CORONARY ARTERY CALCIFICATION IN PATIENTS WITH END-STAGE RENAL DISEASE

目的探讨终末期肾病(ESRD)病人血清骨桥蛋白(OPN)水平与冠状动脉钙化的相关性。方法选取2016年1月—2019年12月在青岛大学附属医院接受冠状动脉造影和血管内超声(IVUS)检查的ESRD病人48例。按照冠状动脉钙化指数(CalcIndex)分为无钙化组、轻度钙化组(CalcIndex≤0.14)和重度钙化组(CalcIndex>0.14)。比较各组临床资料,包括性别、年龄、透析龄、体质量指数(BMI)、既往史(高血压病史、糖尿病病史、吸烟史和服用钙剂史)以及C反应蛋白(CRP)、糖化血红蛋白、血磷、血钙、甲状旁腺激素(iPTH)和碱性磷酸酶(ALP)等实验室指标,分析OPN水平与钙磷相关参数的相关性;采用非条件Logistic回归分析冠状动脉钙化的危险因素;采用受试者工作特征(ROC)曲线评价OPN在冠状动脉钙化诊断中的价值。结果与轻度钙化组相比,重度钙化组病人的年龄、透析龄、高血压病史、糖尿病病史、服用钙剂史、CRP、糖化血红蛋白、血磷、iPTH、钙磷乘积和ALP水平显著增高,差异均有统计学意义(F=3.47~6.48,χ^(2)=3.19~3.28,H=4.32~6.43,P<0.05)。随着冠状动脉钙化程度的加重,ESRD病人血清OPN水平显著升高,差异有统计学意义(F=6.54,P<0.05)。ESRD病人血清OPN水平与血磷、钙磷乘积、iPTH以及ALP均呈正相关(r=0.201~0.399,P<0.05),而与血钙无相关性。Logistic回归分析显示,透析龄、血磷、iPTH、钙磷乘积和血清OPN水平是ESRD病人发生冠状动脉钙化的独立危险因素。ROC曲线分析显示,血清OPN水平诊断冠状动脉钙化的曲线下面积为0.947(95%CI=0.882~0.981,P<0.01),当检测的截点为81.73 ng/L时,其诊断灵敏度和特异度分别为72.5%和75.9%。结论伴有冠状动脉钙化的ESRD病人血清OPN水平显著升高,血清OPN水平是ESRD病人发生冠状动脉钙化的独立危险因素,可作为反映冠状动脉钙化的潜在生物学标志物。

Objective To investigate the association of serum osteopontin(OPN)level and coronary artery calcification in patients with end-stage renal disease(ESRD).Methods A total of 48 patients with ESRD were selected who underwent co-ronarography and intravascular ultrasound in the Affiliated Hospital of Qingdao University from January 2016 to December 2019.According to the coronary artery calcification index(CalcIndex),the patients were divided into non-calcification group,mild-calcification group(CalcIndex≤0.14),and severe-calcification group(CalcIndex>0.14).Clinical data were compared between groups,including sex,age,dialysis vintage,body mass index,medical history(hypertension,diabetes,smoking,and use of calcium supplements),C-reactive protein(CRP),glycosylated hemoglobin,seruma phosphate,serum calcium,intact parathyroid hormone(iPTH),and alkaline phosphatase(ALP).The correlation between OPN level and calcification-related parameters was analyzed.A non-conditional Logistic regression analysis was used to analyze risk factors for coronary artery calcification.A receiver operating characteristic(ROC)curve was used to evaluate the value of OPN in the diagnosis of coronary artery calcification.Results Compared with the mild-calcification group,the severe-calcification group had a significantly older age,a significantly longer dialysis vintage,significantly higher proportions of hypertension history,diabetes history,and calcium use history,as well as significantly higher levels of CRP,glycosylated hemoglobin,serum phosphate,iPTH,calcium phosphate product,and ALP(F=3.47-6.48,χ^(2)=3.19-3.28,H=4.32-6.43,all P<0.05).Serum OPN level was significantly increased as the severity of coronary artery calcification increased(F=6.54,P<0.05).Serum OPN level exhibited significantly positive correlations with serum phosphate,calcium phosphate product,iPTH,and ALP(r=0.201-0.399,all P<0.05),but not with serum calcium.The Logistic regress analysis showed that dialysis vintage,serum phosphate,iPTH,calcium phosphate product,and serum OPN were independent risk factors for coronary artery calcification in patients with ESRD.The ROC curve showed that the area under the curve for OPN diagnosing coronary artery calcification was 0.947(95%CI=0.882-0.981,P<0.01).When the cut-off point of serum OPN level was 81.73 ng/L,the sensitivity and specificity were 72.5%and 75.9%,respectively.Conclusion Serum OPN level is significantly increased in patients with ESRD and coronary artery calcification.It is an independent risk factor for coronary artery calcification in patients with ESRD,and can be complicated as a potential biomarker for coronary artery calcification in patients with ESRD.