分泌型磷蛋白24与维持性血液透析患者心脏瓣膜钙化及心血管事件的相关性研究

The association between the level of secreted phosphoprotein 24 and cardiac valve calcification,cardiovascular events in patients with hemodialysis patients

目的探讨维持性血液透析患者分泌型磷蛋白24(SPP24)水平变化及与心脏瓣膜钙化(CVC)、心血管事件(CVE)的相关性。方法研究对象包括88例维持性血液透析(MHD)患者,采用心脏彩超评估患者CVC情况,根据超声检查结果分为CVC组和无CVC组,采用酶联免疫吸附方法测量SPP24水平,分析SPP24在两组病例中的水平变化,采用二分类logistic回归分析SPP24水平变化与CVC的相关性,并探讨二尖瓣和主动脉瓣联合CVC的影响因素。对病例进行随访,记录CVE发生情况,使用COX回归模型分析CVE的影响因素。结果CVC组47例(53.41%),CVC组SPP24水平低于无CVC组(P=0.040)。二尖瓣和主动脉瓣联合瓣膜钙化22例。二分类logistic回归分析发现,年龄增加(OR=1.055)、高磷血症(OR=8.234)是CVC的危险因素,高SPP24(OR=0.997)是CVC的保护因素。年龄增加(OR=1.086)、高磷血症(OR=7.393)均是联合心脏联合瓣膜钙化的危险因素,高SPP24(OR=0.964)是心脏二尖瓣和主动脉瓣联合瓣膜钙化的保护因素。对病例进行2~14月随访,发生CVE 24例,COX回归分析发现CVC(HR=4.156)增加患者CVE发生风险,高SPP24水平(HR=0.976)降低CVE发生风险。心脏联合瓣膜钙化(HR=3.071)是CVE的危险因素。结论维持性血液透析患者CVC的发生率高达53.41%,年龄增加、高磷血症是CVC的危险因素,高SPP24水平是CVC的保护因素。CVC是CVE的独立危险因素,高SPP24水平是CVE的保护因素。

Objective To explore the level of secreted phosphoprotein 24(SPP24) and its association with cardiac valve calcification(CVC), cardiovascular events(CVE) in patients with hemodialysis patients. Methods Eighty-eight maintenance hemodialysis patients were enrolled in the study. All patients were assessed for cardiac valve calcification by echocardiography. According to the results of echocardiography, patients were divided into two groups: cardiac valve calcification group and the group without cardiac valve calcification. The levels of SPP24 were measured by enzyme-linked immunosorbent assay. Serum SPP24 levels were compared between CVC group and the group without cardiac valve calcification. Binary logistic regression was used to evaluate the association between SPP24 and cardiac valve calcification. The factors for calcification of the mitral and aortic valves were explored. The cases were followed up and cardiovascular events were recorded. COX regression model was used to analyze the factors for cardiovascular events. Results There were 47 patients in CVC group, the levels of SPP24 in CVC group were lower than those in the group without cardiac valve calcification(P=0.040). Twenty-two patients had calcification of the mitral and aortic valves. Logistic regression analysis showed that older age(OR=1.055), hyperphosphatemia(OR=8.234) were risk factors for CVC, higher SPP24(OR=0.997) was a protective factor. Older age(OR=1.086) and hyperphosphatemia(OR=7.393) were risk factors for calcification of the mitral and aortic valves, higher SPP24(OR=0.964) level was a protective factor. Patients were followed up, the follow-up intervals were from 2 to 14 months, and it was found that CVC(HR=4.156) increased the risk of cardiovascular events in hemodialysis patients, high SPP24 level(HR=0.976) reduced the risk of cardiovascular events. Calcification of the mitral and aortic valves increased the risk for cardiovascular events(HR=3.071). Conclusion The incidence of cardiac valve calcification in maintenance hemodialysis patients is as high as 53.41%. Older age and hyperphosphatemia are risk factors for CVC, while high SPP24 level is a protective factor for CVC. CVC is an independent risk factor for cardiovascular events, and high SPP24 level is a protective factor for cardiovascular events.