血清Runx2 mRNA表达与尿毒症患者动脉血管钙化的关系研究

The study on the relationship between serum Runx2 gene expression and arterial vascular calcification in patients with uremia

目的探讨血清Runt相关转录因子2(Runx^(2))mRNA表达与尿毒症患者动脉血管钙化的关系。方法选取行自体动静脉内瘘成形术及切除重造术的尿毒症患者78例并收集患者的血管组织、血清样本及临床资料。根据硝酸银染色结果进行钙化评分,并将患者分为钙化组(n=23)和未钙化组(n=55)。采用免疫组化法检测血管组织的Runx^(2)表达水平,实时荧光定量PCR检测血清Runx^(2) mRNA表达水平。比较2组患者临床各指标的变化,通过线性回归分析各指标对血管钙化的影响因素,通过受试者工作特征(ROC)曲线评价血清Runx^(2) mRNA表达水平对血管钙化的预测能力。结果硝酸银染色结果显示,与未钙化组比较,钙化组黑色沉积显著增多;免疫组化结果显示,钙化组Runx^(2)评分显著增高(P<0.01)。与未钙化组比较,钙化组年龄、透析龄、血清Runx^(2) mRNA表达水平、血磷、全段甲状旁腺素(iPTH)均显著增高,血白蛋白和血钙显著降低(P<0.05)。Spearman相关分析显示,血清Runx^(2) m RNA水平、年龄、透析龄、血磷、i PTH、Runx^(2)评分与钙化评分呈正相关,血白蛋白和血钙与钙化评分呈负相关(P<0.05)。多元线性回归分析结果显示,血清Runx^(2) mRNA表达水平升高、高透析龄、低血钙是尿毒症患者动脉血管钙化的影响因素(P<0.05)。ROC曲线分析显示,血清Runx^(2) mRNA、透析龄和血钙三者联合诊断预测血管钙化的曲线下面积(AUC)为0.934。结论血清Runx^(2) mRNA表达是尿毒症患者动脉血管钙化的独立危险因素,可能成为诊断预测尿毒症患者动脉血管钙化的生物标志物。

Objective To explore the relationship between serum runt-related transcription factor 2(Runx^(2))mRNA expression and arterial calcification in patients with uremia.Methods A total of 78 uremic patients who underwent autologous arteriovenous fistula plasty and resection and reconstruction in our hospital were selected as the research objects,and blood vessel tissue,serum samples and clinical data of patients were collected.The calcification score were based on silver nitrate results,the patients were divided into the calcified group(n=23)and the non-calcified group(n=55).The expression level of Runx^(2) in blood vessel tissue was detected by immunohistochemistry,and the expression level of Runx^(2) mRNA in serum was detected by real-time fluorescence quantitative method.The changes of clinical indicators were compared between the two groups.The factors affecting vascular calcification of each indicator were analyzed by linear regression,and the predictive ability of serum Runx^(2) mRNA on vascular calcification was evaluated by ROC curve.Results The results of silver nitrate staining showed that compared with the non-calcified group,the black deposits were significantly increased in the calcified group.The immunohistochemical results showed that the Runx^(2) score was significantly increased in the calcified group(P<0.05).Compared with the non-calcified group,the age,dialysis age,blood phosphorus,iPTH and serum Runx^(2) mRNA expression levels were significantly increased in the calcified group(P<0.05),and serum albumin and blood calcium were significantly decreased(P<0.05).Spearman correlation analysis showed that age,dialysis age,blood phosphorus,iPTH,serum Runx^(2) mRNA,Runx^(2) score were positively correlated with calcification score,and serum albumin and blood calcium were negatively correlated with calcification score(P<0.05).The results of multiple linear regression analysis showed that the elevated serum Runx^(2) mRNA expression levels,long dialysis age and hypocalcemia were independent risk factors for arterial vascular calcification in patients with uremia(P<0.05).ROC curve analysis showed that the area under the ROC curve(AUC)of serum Runx^(2) mRNA combined with dialysis age and blood calcium to diagnose vascular calcification was 0.934.Conclusion Serum Runx^(2) mRNA expression is an independent risk factor for arterial vascular calcification in uremic patients,and which may be a biomarker for the diagnosis and prediction of arterial vascular calcification in uremic patients.