慢性肾脏病5期维持性血液透析患者外周血生长激素促分泌素、NOD样受体蛋白3水平与血管钙化的相关性

Correlation between peripheral blood ghrelin,NLRP3 levels and vascular calcification in patients with chronic kidney disease(CKD)-stage 5 maintenance hemodialysis

目的探讨慢性肾脏病(chronic kidney disease,CKD)-5期维持性血液透析患者外周血生长激素促分泌素(ghrelin)、NOD样受体蛋白3(NOD-likereceptorprotein3,NLRP3)水平与血管钙化之间相关性。方法选取中国人民解放军海军第九七一医院2018年8月至2021年2月收治的126例CKD-5期维持性血液透析患者为观察对象,根据是否合并血管钙化分为钙化组92例和未钙化组34例。采用酶联免疫吸附测定法检测外周血ghrelin水平,用实时PCR技术检测外周血中NLRP3 mRNA水平,比较不同血管钙化程度患者外周血ghrelin、NLRP3水平,并分析两者与血管钙化指标之间的相关性。结果钙化组患者血磷(P)、钙磷乘积(Ca×P)、碱性磷酸酶(alkaline phosphatase,ALP)及骨保护素(osteoprotegerin,OPG)水平相较于未钙化组均明显升高,Ca水平明显下降(P<0.001);与未钙化组比较,钙化组患者NLRP3 mRNA水平、超敏C反应蛋白(high-sensitivity C-reactiveprotein,hs-CRP)、白细胞介素6(interleukin-6,IL-6)炎症因子水平及血管钙化评分明显升高,ghrelin水平明显下降,差异有显著性(P<0.001)。Logistic回归分析结果显示:血Ca、hs-CRP、IL-6、ghrelin、NLRP3水平均是影响CKD患者发生血管钙化的独立危险因素(P<0.05)。血管重度钙化患者外周血Ca、ghrelin低于轻、中度钙化组(P<0.05),而其NLRP3、hs-CRP、IL-6水平显著高于轻、中度钙化组(P<0.05)。相关分析结果显示,CKD患者外周血ghrelin水平与血Ca呈显著正相关(r=0.618,P<0.05),与血管钙化积分呈显著负相关(r=-0.654,P<0.05);NLRP3水平与血Ca呈显著负相关(r=-0.697,P<0.05),与血管钙化积分呈显著正相关(r=0.714,P<0.05)。结论CKD-5期维持性血液透析患者外周血ghrelin、NLRP3水平是影响血管钙化的独立危险因素,ghrelin、NLRP3水平分别与血管钙化程度呈显著负相关和正相关。

Objective To investigate the correlation between the levels of growth hormone secretagogue(ghrelin),nod like receptor protein 3(NLRP3)and vascular calcification in patients with chronic kidney disease(CKD)-stage 5 maintenance hemodialysis.Method 126patients with CKD-5 stage maintenance hemodialysis in our hospital from August 2018 to February 2021 were selected as the observation objects,and they were divided into 92 cases in the calcification group and 34 cases in the non-calcification group according to whether they had vascular calcification.Enzyme linked immunosorbent assay was used to detect peripheral blood ghrelin levels,and real-time PCR technology was used to detect NLRP3 mRNA levels in peripheral blood.Logistic regression analysis was used to analyze the independent risk factors affecting vascular calcification in patients with CKD-5 stage nephropathy.The levels of peripheral blood ghrelin and NLRP3 in patients with different vascular calcification levels were compared,and the correlation between the two and vascular calcification indexes was analyzed.Result The levels of P,Ca×P,ALP and OPG in the calcification group were significantly higher than those in the noncalcified group,and the Ca level was significantly decreased(P<0.001);compared with the non-calcified group,the levels of NLRP3mRNA and hs-CRP,IL-6 and the vascular calcification score were significantly increased,and the level of ghrelin was significantly decreased,and the difference were statistically significant(P<0.001).Logistic regression analysis results showed:blood Ca,hs-CRP,IL-6,ghrelin,NLRP3 level were the independent risk factors that affect vascular calcification in patients with CKD(P<0.05).Peripheral blood Ca and ghrelin in patients with severe vascular calcification were lower than those in the mild and moderate calcification groups(P<0.05),while NLRP3 mRNA,hs-CRP and IL-6 levels were significantly higher than those in the mild and moderate calcification groups(P<0.05).The results of correlation analysis showed that the level of ghrelin in peripheral blood of CKD patients was significantly positively correlated with blood Ca(r=0.618,P<0.05),and was significantly negatively correlated with the vascular calcification score(r=-0.654,P<0.05).Blood Ca was significantly negatively correlated(r=-0.697,P<0.05),and significantly positively correlated with vascular calcification score(r=0.714,P<0.05).Conclusion The levels of ghrelin and NLRP3 in peripheral blood of CKD-5 maintenance hemodialysis patients were independent risk factors for vascular calcification,and the levels of ghrelin and NLRP3 were significantly negatively and positively correlated with the degree of vascular calcification,respectively.