维持性血液透析患者血清骨桥蛋白、成纤维细胞生长因子23与血管钙化的关系

Relation between serum osteopontin,fibroblast growth factor 23 levels and vascular calcification in maintenance hemodialysis patients

目的探讨维持性血液透析(MHD)患者骨桥蛋白(OPN)、成纤维细胞生长因子23(FGF23)与血管钙化的关系。方法选取2018年1月—2022年6月海安市人民医院MHD患者147例。收集所有患者一般资料、实验室常规检测结果,并检测血清OPN和FGF23水平。使用腹部、骨盆和双手X线片对所有患者的血管钙化情况进行血管钙化评分,总分为10分。根据血管钙化评分总分将患者分为无血管钙化(总分0分)组(49例)、血管钙化1~5分组(74例)和血管钙化6~10分组(24例)。结果无血管钙化组、血管钙化1~5分组和血管钙化6~10分组透析时间和总钙、磷、全段甲状旁腺激素(iPTH)、OPN、FGF23水平依次升高(P<0.05),血红蛋白(Hb)水平和Kt/V比值依次降低(P<0.05)。长透析时间[比值比(OR)=1.070]、高总钙(OR=2.540)、高磷(OR=4.170)、高OPN(OR=1.010)和高FGF23(OR=1.060)是MHD患者血管钙化的危险因素,而高Kt/V比值(OR=0.020)是血管钙化的保护因素。磷的一致性(真阳性率+真阴性率)最高,其与OPN的一致性比较差异无统计学意义(P=0.89),但显著高于FGF23(P=0.02)。结论MHD患者OPN和FGF23异常升高与血管钙化关系密切,是潜在的干预靶点。

Objective To investigate the relation between osteopontin(OPN),fibroblast growth factor 23(FGF23)and vascular calcification in maintenance hemodialysis(MHD)patients.Methods Totally,147 patients with MHD at Hai'an People's Hospital from January 2018 to June 2022 were enrolled.The general data and laboratory routine test results of all the patients were collected,and serum OPN and FGF23 levels were determined.The patients'vascular calcification was scored by X-ray images of abdomen,pelvis and hands,and the total score was 10 points.According to the total score of vascular calcification,the patients were classfied into non-vascular calcification group(total score 0)(49 cases),vascular calcification total score 1 to 5 group(74 cases)and vascular calcification total score 6 to 10 group(24 cases).Results The dialysis time,the levels of total calcium,phosphorus,intact parathyroid hormone(iPTH),OPN and FGF23 were increased successively in non-vascular calcification group,vascular calcification total score 1 to 5 group and vascular calcification total score 6 to 10 group(P<0.05),and the hemoglobin(Hb)level and Kt/V ratio were decreased successively(P<0.05).Long dialysis time[odds ratio(OR)=1.070],high total calcium(OR=2.540),high phosphorus(OR=4.170),high OPN(OR=1.010)and high FGF23(OR=1.060)were risk factors for vascular calcification in MHD patients.High Kt/V ratio(OR=0.020)was a protective factor for vascular calcification.The consistency(true positive rate+true negative rate)of phosphorus was the highest,but there was no statistical significance between those of phosphorus and OPN(P=0.89),and it was higher than that of FGF23(P=0.02).Conclusions The abnormal increase of OPN and FGF23 in MHD patients is related to vascular calcification,and they are potential intervention targets.