血清sclerostin和Klotho蛋白水平对维持性血液透析患者血管钙化的预测价值

Predictive value of serum sclerostin and Klotho protein levels for angiosteosis in patients undergoing maintenance hemodialysis

目的探讨血清sclerostin、Klotho蛋白水平对维持性血液透析(MHD)患者血管钙化的预测价值。方法选择2017年10月至2019年10月南阳市中心医院收治的105例MHD患者为研究对象,根据是否有血管钙化将患者分为血管钙化组(n=69)和非血管钙化组(n=36)。通过查阅病历采集2组患者的临床资料,采用单因素分析和多因素logistic回归分析MHD患者血管钙化的影响因素,采用受试者工作特征(ROC)曲线评估血清sclerostin、Klotho蛋白水平对MHD患者血管钙化的预测价值。结果单因素分析结果显示,性别、年龄、体质量指数、吸烟史、饮酒史、原发疾病、血清肌酐、血尿素氮、尿素清除指数、血红蛋白、白蛋白、血清超敏C反应蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、收缩压、舒张压、血清磷、钙磷乘积与MHD患者血管钙化无关(P>0.05),而透析龄及校正的血清钙、全段甲状旁腺激素、sclerostin蛋白、Klotho蛋白与MHD患者血管钙化有关(P<0.05)。多因素logistic回归分析结果显示,透析龄及校正的血清钙、全段甲状旁腺激素、sclerostin蛋白为MHD患者血管钙化的独立危险因素,而血清Klotho蛋白为MHD患者血管钙化的独立保护因素(P<0.05)。ROC曲线显示,血清sclerostin、Klotho蛋白预测MHD患者血管钙化的曲线下面积(AUC)分别为0.870、0.840;以血清sclerostin蛋白87.575 pmol·L^(-1)、Klotho蛋白393.220 ng·L^(-1)为最佳临界值,血清sclerostin蛋白预测MHD患者血管钙化的敏感度和特异度分别为71.0%、88.9%,血清Klotho蛋白预测MHD患者血管钙化的敏感度和特异度分别为73.9%、94.4%;血清sclerostin、Klotho蛋白联合检测预测MHD患者血管钙化的AUC、敏感度和特异度分别为0.903、85.5%、97.2%;血清sclerostin蛋白与Klotho蛋白预测MHD患者血管钙化的AUC、敏感度、特异度比较差异均无统计学意义(P>0.05);血清sclerostin、Klotho蛋白联合检测预测MHD患者血管钙化的AUC、敏感度和特异度显著高于二者单独检测(P<0.05)。结论血清sclerostin、Klotho蛋白与MHD患者的血管钙化有关,血清sclerostin蛋白为MHD患者血管钙化的独立危险因素,而血清Klotho蛋白为MHD患者血管钙化的独立保护因素;血清sclerostin、Klotho蛋白对MHD患者的血管钙化均有一定的预测价值,且二者联合检测的预测价值较高,血清sclerostin、Klotho蛋白可作为MHD患者血管钙化的预测指标。

Objective To investigate the predictive value of serum sclerostin and Klotho protein levels for angiosteosis in patients undergoing maintenance hemodialysis(MHD).Methods A total of 105 MHD patients admitted to Nanyang Central Hospital from October 2017 to October 2019 were selected as the research subjects,and the patients were divided into angiosteosis group(n=69)and non-angiosteosis group(n=36)according to whether there was angiosteosis.The clinical data of patients in the two groups were collected by consulting the case history.The influencing factors of angiosteosis in MHD patients were analyzed by univariate analysis and multivariate logistic regression.The predictive value of serum sclerostin and Klotho protein levels on angiosteosis in MHD patients was evaluated by receiver operating characteristic(ROC)curve.Results The univariate analysis showed that the gender,age,body mass index,smoking history,drinking history,primary disease,serum creatinine,blood urea nitrogen,urea clearance index,hemoglobin,albumin,serum high-sensitivity C-reactive protein,total cholesterol,triacylglycerol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,systolic blood pressure,diastolic blood pressure,serum phosphorus and calcium-phosphorus product were not associated with angiosteosis in MHD patients(P>0.05),while the dialysis age,corrected serum calcium,intact parathyroid hormone,sclerostin protein and Klotho protein were related to angiosteosis in MHD patients(P<0.05).The multivariate logistic regression showed that the dialysis age,corrected serum calcium,intact parathyroid hormone and sclerostin protein were independent risk factors for angiosteosis in MHD patients,while serum Klotho protein was an independent protective factor for angiosteosis in MHD patients(P<0.05).The ROC curve showed that the area under curve(AUC)of serum sclerostin and Klotho proteins for predicting angiosteosis in MHD patients was 0.870 and 0.840,respectively.Taking serum sclerostin protein 87.575 pmol·L^(-1)and Klotho protein 393.220 ng·L^(-1)as the optimal cut-off values,the sensitivity and specificity of serum sclerostin protein in predicting angiosteosis in MHD patients were 71.0%and 88.9%,respectively;the sensitivity and specificity of serum Klotho protein in predicting angiosteosis in MHD patients were 73.9%and 94.4%,respectively;the AUC,sensitivity and specificity of the combined detection of serum sclerostin and Klotho proteins in predicting angiosteosis in MHD patients were 0.903%,85.5%and 97.2%,respectively.There was no significant difference in AUC,sensitivity and specificity between serum sclerostin protein and Klotho protein in predicting angiosteosis in MHD patients(P>0.05).The AUC,sensitivity and specificity of the combined detection of serum sclerostin and Klotho protein in predicting angiosteosis in MHD patients were significantly higher than those detected alone(P<0.05).Conclusion The serum sclerostin and Klotho proteins are related to angiosteosis in MHD patients,the serum sclerostin protein is an independent risk factor for angiosteosis,while the serum Klotho protein is an independent protective factor for angiosteosis in MHD patients.The serum sclerostin protein and Klotho protein have certain predictive value for angiosteosis in MHD patients,and the combined detection of them has higher predictive value.The serum sclerostin protein and Klotho protein can be used as predictors of angiosteosis in MHD patients.