CKD-Ⅴ期糖尿病肾病患者血管钙化与血清CTRP3、VK2水平的关系

Relationships between serum CTRP3 and VK2 levels and vascular calcification in patients with CKD-V DN

目的探讨慢性肾脏病Ⅴ期(CKD-Ⅴ期)糖尿病肾病(DN)患者血管钙化与血清补体1q/肿瘤坏死因子相关蛋白3(CTRP3)、维生素K2(VK2)水平的关系。方法选择CKD-Ⅴ期DN患者103例,根据是否存在血管钙化分为有钙化组33例、无钙化组70例,采集清晨空腹肘静脉血,采用酶联免疫吸附法检测血清CTRP3、VK2。比较两组血清CTRP3、VK2水平,分析CKD-Ⅴ期DN患者有血管钙化者血清CTRP3、VK2水平与血管钙化积分的关系。比较两组一般临床资料(包括性别、年龄、BMI、糖尿病病程、吸烟史、血压)、实验室检查资料[包括血脂(TC、TG、HDL-C、LDL-C)、空腹血糖、血钙、血磷、甲状旁腺激素(PTH)、CTRP3、VK2]及估算的肾小球滤过率,将有统计学差异的指标纳入多因素Logistic回归模型,分析CKD-Ⅴ期DN患者发生血管钙化的危险因素。采用受试者工作特征(ROC)曲线评估血清CTRP3、VK2水平对CKD-Ⅴ期DN患者发生血管钙化的预测价值。结果有钙化组血清CTRP3水平明显高于无钙化组,血清VK2水平明显低于无钙化组(t分别为-6.795、-4.916,P均<0.01)。Pearson相关分析显示,CKD-Ⅴ期DN患者有血管钙化者血清CTRP3水平与血管钙化积分呈正相关关系(r=0.634,P<0.01),而血清VK2水平与血管钙化积分呈负相关关系(r=-0.687,P<0.01)。多因素Logistic回归分析显示,PTH、CTRP3为CKD-Ⅴ期DN患者发生血管钙化的独立危险因素,而VK2则为其独立保护因素(P均<0.05)。ROC曲线分析显示,血清CTRP3、VK2水平对CKD-Ⅴ期DN患者发生血管钙化均有一定预测价值,但血清CTRP3、VK2水平联合预测CKD-Ⅴ期DN患者发生血管钙化的曲线下面积明显大于二者单独预测(P均<0.05)。结论CKD-Ⅴ期DN患者发生血管钙化后血清CTRP3水平明显升高,血清VK2水平明显降低。血清CTRP3水平为CKD-Ⅴ期DN患者发生血管钙化的独立危险因素,而血清VK2水平则为其独立保护因素。血清CTRP3、VK2水平对CKD-Ⅴ期DN患者发生血管钙化均有一定预测价值,但二者联合时预测价值更高。

Objective To investigate the relationships between serum levels of complement 1q/tumor necrosis factor related protein 3(CTRP3)and vitamin K2(VK2)and vascular calcification in chronic kidney disease(CKD)patients with stage V diabetic nephropathy(DN).Methods Totally 103 patients with CKD-V DN were selected and divided into the calcified group of 33 cases and the non-calcified group of 70 cases according to the presence of vascular calcification.Fasting elbow venous blood was collected in the morning,and serum CTRP3 and VK2 were detected by enzyme-linked immunosorbent assay.The levels of serum CTRP3 and VK2 were compared between the two groups,and the relationships between the levels of serum CTRP3 and VK2 and vascular calcification score in patients with CKD-V DN with vascular calcification was analyzed.The general clinical data[gender,age,BMI,duration of diabetes,smoking history(>1 piece/day,continuous for 6 months)],blood pressure(systolic and diastolic blood pressure),laboratory data[blood lipids(TC,TG,HDL-C,and LDL-C),fasting blood glucose,blood calcium,phosphorus,parathyroid hormone(PTH),CTRP3,VK2]and estimated glomerular filtration rate of the two groups were collected and compared.The statistically different indexes were included in the multivariate Logistic regression model to analyze the risk factors for vascular calcification in patients with CKD-V DN.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum CTRP3 and VK2 levels for vascular calcification in patients with CKD-V DN.Results The level of serum CTRP3 in the calcified group was significantly higher than that in non-calcified group,and the level of serum VK2 was significantly lower than that in non-calcified group(t=-6.795 and-4.916,respectively,both P<0.01).Pearson correlation analysis showed that serum CTRP3 level was positively correlated with vascular calcification score in patients with CKD-V DN(r=0.634,P<0.01),while serum VK2 level was negatively correlated with vascular calcification score(r=-0.687,P<0.01).Multivariate Logistic regression analysis showed that PTH and CTRP3 were independent risk factors for vascular calcification in patients with CKD-V DN,while VK2 was independent protective factor(all P<0.05).ROC curve analysis showed that the levels of serum CTRP3 and VK2 had certain predictive value for vascular calcification in patients with CKD-V DN,but the AUC of serum CTRP3 and VK2 in predicting vascular calcification in patients with CKD-V DN was significantly greater than that of either alone(both P<0.05).Conclusions After vascular calcification in patients with CKD-V DN,the level of serum CTRP3 increases significantly and the level of serum VK2 decreases significantly.Serum CTRP3 level is an independent risk factor for vascular calcification in patients with CKD-V DN,while serum VK2 level is an independent protective factor.The levels of serum CTRP3 and VK2 have certain predictive value for vascular calcification in patients with CKD-V DN,but the predictive value of them combined is higher.