维持性血液透析患者血清GRP78、BMP2水平及其与血管钙化的相关性

The levels of serum GRP78 and BMP2 in maintenance hemodialysis patients and their correlation with vascular calcification

目的探究维持性血液透析(maintenance hemodialysis,MHD)患者血清葡萄糖调节蛋白78(glucose regulatory protein 78,GRP78)、骨形态发生蛋白2(bone morphogenetic protein 2,BMP2)水平及其与血管钙化(vascular calcification,VC)的相关性。方法选取2020年4月~2022年5月三河燕郊福合第一医院收治的MHD患者为研究对象。收集临床资料,检测血清GRP78、BMP2水平并统计VC发生情况;分析MHD患者及VC患者血清GRP78、BMP2水平与一般临床资料的相关性,MHD患者发生VC的危险因素。结果共纳入112例患者,52例发生轻中度钙化(轻中度钙化组),21例发生重度钙化(重度钙化组),39例未发生钙化(无钙化组);无钙化组、轻中度钙化组、重度钙化组年龄、糖尿病比例、白蛋白(Alb)、血红蛋白(Hb)、血磷、血钙、钙磷乘积、全段甲状旁腺激素(iPTH)、血清GRP78、BMP2水平差异有统计学意义(F/χ^(2)=38.987、20.187、34.952、43.411、34.541、11.572、48.522、598.639、123.029、259.490,P均<0.001);MHD患者血清GRP78与BMP2水平呈正相关(r=0.490,P<0.001);VC患者血清GRP78与年龄、糖尿病、血磷、血钙、钙磷乘积、iPTH呈正相关(r=0.581、0.339、0.516、0.534、0.611、0.513,P均<0.001),与Alb、Hb呈负相关(r=-0.302、-0.296,P=0.005、0.007);VC患者血清BMP2与年龄、糖尿病、血磷、血钙、钙磷乘积、iPTH呈正相关(r=0.524、0.415、0.535、0.547、0.602、0.498,P均<0.001),与Alb、Hb呈负相关(r=-0.298、-0.284,P=0.008、0.011);年龄、钙磷乘积、iPTH、GRP78、BMP2为MHD患者发生VC的危险因素(OR值分别为3.009、4.321、4.719、6.679、6.237;95%CI分别为1.337~6.774、1.634~11.423、1.693~13.153、1.951~22.871、1.962~19.824;P值分别为0.008、0.003、0.003、0.002、0.002)。结论MHD患者血清GRP78、BMP2水平与VC的发生和病情有关,二者水平升高是VC发生的危险因素。

Objective To explore the levels of serum glucose regulatory protein 78(GRP78)and bone morphogenetic protein 2(BMP2)in patients with maintenance hemodialysis(MHD)and their correlation with vascular calcification(VC).Methods During April 2020 to May 2022,112 patients with MHD admitted to Sanhe Yanjiao Fuhe first hospital were selected as the study objects.Clinical data were collected,serum GRP78 and BMP2 levels were detected,and the incidence of VC was counted;the correlation between serum GRP78 and BMP2 levels in MHD patients,serum GRP78 and BMP2 levels in VC patients and general clinical data were analyzed,and the risk factors of VC in MHD patients.Results Among the 112 patients included,52 had mild to moderate calcification(mild and moderate calcification group),21 patients had severe calcification(severe calcification group),39 patients did not develop VC(non-calcification group);There were significantly differences in age,proportion of diabetes,albumin(Alb),hemoglobin(Hb),blood phosphorus,serum calcium,calcium phosphorus product,intact parathyroid hormone(iPTH),serum GRP78,BMP2 levels among the non-calcification group,mild and moderate calcification group,severe calcification group(F/c2=38.987,20.187,34.952,43.411,34.541,11.572,48.522,598.639,123.029,259.490,all P<0.001);there was a positive correlation between serum GRP78 and BMP2 in MHD patients(r=0.490,P<0.001);the level of serum GRP78 in VC patients was positively correlated with age,diabetes,blood phosphorus,blood calcium,calcium phosphorus product and iPTH(r=0.581,0.339,0.516,0.534,0.611,0.513,all P<0.001),and negatively correlated with Alb and Hb(r=-0.302,-0.296,P=0.005,0.007);the level of serum BMP2 in VC patients was positively correlated with age,diabetes,blood phosphorus,blood calcium,calcium phosphorus product and iPTH(r=0.524,0.415,0.535,0.547,0.602,0.498,all P<0.001),and negatively correlated with Alb and Hb(r=-0.298,-0.284,P=0.008,0.011);age,calcium phosphorus product,iPTH,GRP78 and BMP2 were the risk factors of VC in MHD patients(OR values are 3.009,4.321,4.719,6.679,6.237 respectively;95%CI were 1.337~6.774,1.634~11.423,1.693~13.153,1.951~22.871,1.962~19.824 respectively;P values were 0.008,0.003,0.003,0.002,0.002 respectively).Conclusion The serum levels of GRP78 and BMP2 in MHD patients are related to the occurrence and condition of VC,the elevated levels of GRP78 and BMP2 are risk factors for the occurrence of VC.