血液透析患者血清牙本质基质蛋白1与矿物质代谢及骨密度的关系

Relationship between serum dentin matrix protein 1 and the status of mineral metabolism and bone mineral density in hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者血清牙本质基质蛋白1(dentin matrix protein 1,DMP1)与矿物质代谢及骨密度的关系。方法以2019年7月~2020年7月于青岛大学附属青岛市市立医院血液净化中心行MHD治疗的95名患者作为研究对象。收集研究对象的临床资料和实验室检查结果,ELISA测定血清DMP1水平,双能X线吸收法检测MHD患者股骨颈骨密度。采用Spearman相关性分析、多元线性回归分析MHD患者血清DMP1水平的影响因素。二元Logistic回归分析MHD患者发生骨密度低下的影响因素。结果①MHD患者的血清DMP1水平低于健康人群,差异有统计学意义(Z=-3.218,P=0.001)。②Spearman相关性分析显示DMP1水平与年龄、透析龄呈负相关,与肾小球滤过率(eGFR)、甲状旁腺激素(PTH)、股骨颈骨密度T值呈正相关(r值分别为-0.226,-0.223,0.210,0.294,0.370;P值分别为0.028,0.030,0.041,0.004,<0.001)。多元线性回归分析显示,血清DMP1水平的独立影响因素是PTH和股骨颈骨密度T值(β值分别为0.211,0.399;P值分别为0.032,0.001)。③二元Logistic回归分析显示,在调整了年龄、透析龄、白蛋白、碱性磷酸酶和血钙等混杂因素后,血清高DMP1水平是MHD患者发生骨密度低下的独立保护因素(OR:0.913,95%CI:0.845~0.986,P=0.020)。结论MHD患者的血清DMP1水平较健康人群低,且与矿物质代谢及骨密度相关。

Objective To investigate the relationship between serum level of dentin matrix protein 1(DMP1)and the status of mineral metabolism and bone density in maintenance hemodialysis(MHD)patients.Methods A total of 95 MHD patients treated at the Blood Purification Center of Qingdao Municipal Hospital from July 2019 to July 2020 were recruited as the research objects.Their clinical data and laboratory test results were collected,serum DMP1 was determined by ELISA,and femoral neck bone mineral density was assayed by dual-energy X-ray absorptiometry.The influencing factors for serum DMP1 level were evaluated by Spearman correlation analysis and multivariate linear regression,and the influencing factors for low bone mineral density were assessed by binary logistic regression.Results①Serum DMP1 level was lower in the MHD patients than in the healthy controls(Z=-3.218,P=0.001).②Spearman correlation analysis showed that DMP1 level was negatively correlated with age and dialysis duration,and positively correlated with eGFR,PTH,and T-score of femoral neck bone mineral density(r=-0.226,-0.223,0.210,0.294 and 0.370,respectively;P=0.028,0.030,0.041,0.004 and<0.001,respectively).Multivariate linear regression demonstrated that PTH and T-score of femoral neck bone mineral density were the independent influencing factors for serum DMP1 level(β=0.211 and 0.399,respectively;P=0.032 and 0.001,respectively).③Binary logistic regression found that higher serum DMP1 level was an independent protective factor for the lower bone mineral density in MHD patients(OR=0.913,95%CI 0.845~0.986,P=0.020)after adjusting the confounding factors including age,dialysis age,albumin,alkaline phosphatase and serum calcium.Conclusions Serum DMP1 level in MHD patients is lower than that in healthy controls,and the lower serum level is related to the changes of mineral metabolism and bone density.