FGF-21、BMP-2在维持性血液透析病人自体动静脉内瘘血管钙化中的作用

Effect of the FGF-21 and BMP-2 on vascular calcification of autologous arteriovenous fistula in maintenance hemodialysis patients

目的:探讨成纤维细胞生长因子-21(FGF-21)及骨形态发生蛋白-2(BMP-2)在维持性血液透析病人自体动静脉内瘘血管钙化中的作用。方法:选取蚌埠医学院第一附属医院肾病科维持性血液透析的病人中行内瘘修复术及慢性肾脏病4~5期初次内瘘术者各20例为观察组,并选取同期健康体检中心年龄、性别与之相匹配的健康人群20名为对照组。在观察组建立自体动静脉内瘘手术时留取修剪下的内瘘血管组织(初瘘病人的头静脉组织,修瘘病人的“静脉动脉化”的头静脉),行茜素红S染色检测有无钙化,并计算钙化积分进行钙化分级(重度钙化组和轻、中度钙化组、无钙化组)。收集所有研究对象临床基本资料、血清生化指标及肱踝脉搏波传导速度(baPWV)值;酶联免疫吸附法测定所有研究对象FGF-21和BMP-2血清浓度;免疫组织化学检测观察组内瘘血管壁上FGF-21和BMP-2的表达情况。结果:观察组血清FGF-21和BMP-2水平明显高于对照组(P<0.01)。随着血管钙化程度加重FGF-21和BMP-2在血清中水平越高,FGF-21及BMP-2在钙化程度越高的血管壁上的免疫组织表达也越强(P<0.05)。观察组血清FGF-21、BMP-2、血磷、肌酐、甲状旁腺激素水平及baPWV值与内瘘血管钙化呈正相关(r_(s)=0.850、0.769、0.718、0.433、0.441、0.457,P<0.01)。结论:FGF-21及BMP-2与维持性血液透析病人自体动静脉内瘘血管钙化存在一定的相关性,可作为监测内瘘血管钙化的参考依据。

Objective:To investigate the effects of fibroblast growth factor-21(FGF-21)and bone morphogenetic protein-2(BMP-2)on vascular calcification of autologous arteriovenous fistula(AVF)in maintenance hemodialysis patients.Methods:Twenty maintenance hemodialysis patients treated with internal fistula repair and 20 patients treated with primary internal fistula operation at stage 4-5 of chronic kidney disease in the Department of Nephrology of The First Affiliated Hospital of Bengbu Medical College were selected as the observation group,and 20 healthy people matched with age and gender in the health examination center were selected as the control group.The internal fistula blood vessels from establishing autogenous arteriovenous fistula operation(cephalic vein tissue of early fistula patients or arterialized venous cephalic vein of repairing fistula patients)were stained with alizarin red S to detect the presence of calcification,and calculate the calcification score for calcified stage(including severe calcification group,light and moderate calcification group and noncalcification group).The clinical data,serum biochemical parameters,and brachial and ankle pulse wave conduction velocity(baPWV)in all cases were collected.The serum concentrations of FGF-21 and BMP-2 in all cases were determined by ELISA,the immunohistochemistry was used to detect the expression levels of FGF-21 and BMP-2 in the vascular wall of internal fistula in the observation group.Results:The serum levels of FGF-21 and BMP-2 in observation group were significantly higher than those in control group(P<0.01).With the aggravation of vascular calcification,the serum levels of FGF-21 and BMP-2 increased,and the expression levels of FGF-21 and BMP-2 in the immune tissue of the vascular wall with higher calcification degree also increased(P<0.05).The levels of FGF-21,BMP-2,serum phosphorus,creatinine,parathyroid hormone and baPWV in the observation group were positively correlated with the vascular calcification of internal fistula(r s=0.850,0.769,0.718,0.433,0.441 and 0.457,respectively)(P<0.01).Conclusions:The levels of FGF-21 and BMP-2 are correlated with the vascular calcification of autologous arteriovenous fistula in patients with maintenance hemodialysis,which can be used as the reference for monitoring the vascular calcification of internal fistula.