中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (04): 225-230.doi: 10.3969/j.issn.1671-4091.2022.04.001

• 临床研究 •    下一篇

CHI3L1 水平与不同性别腹膜透析患者腹主动脉钙化的相关性研究

周思佳1,何莲1,韩庆烽1,唐雯1,张爱华2   

  1. 1北京大学第三医院肾内科
    2首都医科大学宣武医院肾内科

  • 收稿日期:2021-10-09 修回日期:2021-11-30 出版日期:2022-04-12 发布日期:2022-04-07
  • 通讯作者: 张爱华 zhangaihua0982@sina.com； 唐雯 tanggwen@126.com(张爱华和唐雯为共同通讯作者) E-mail:zhangaihua0982@sina.com
  • 基金资助:

    国家自然科学基金项目(81873619、81570663)；

    北大百度基金资助项目(2020BD030)；

    中华国际医学交流基金会基金(Z-2017-24-2037)

Gender-specific association between serum CHI3L1 and abdominal aortic calcification in peritoneal dialysis patients 

  1. 1Department of Nephrology, Peking University Third Hospital, Beijing 100191, China;  2Department of Nephrology, Xuanwu Hospital Capital Medical University, Beijing100053, China
  • Received:2021-10-09 Revised:2021-11-30 Online:2022-04-12 Published:2022-04-07

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摘要： 【摘要】目的探究血清壳多糖酶3样蛋白1(chitinase-3-like protein 1,CHI3L1)水平与不同性别腹膜透析(peritoneal dialysis,PD)患者血管钙化的相关性。方法本研究为横断面研究，研究对象为116例行规律PD治疗超过6个月的慢性肾衰竭患者，利用侧位腹平片评估入组患者腹主动脉钙化(abdominal aortic calcification,AAC)程度。根据Kauppila 评分系统行AAC 评分，AAC 评分＜4 为低AAC 评分组，AAC评分≥4为高AAC评分组。收集患者的人口统计学资料、实验室化验数据。利用生物电阻抗原理测定体成分。通过酶联免疫吸附法测定血清CHI3L1。结果共纳入男性PD 患者56 例、女性60 例，平均年龄(57.0±13.7)岁，61 例(52.6%)患者AAC 评分≥4。女性PD 患者血清CHI3L1 水平高于男性(Z =-3.435，P =0.001)。男性PD 患者高AAC 评分组的血清CHI3L1 水平高于低AAC 评分组，但差异不显著[(285.9±100.3)ng/ml比(238.4±106.8)ng/ml，t=-1.701,P=0.095]；女性PD患者高AAC评分组的血清CHI3L1水平高于低AAC 评分组[437.7(314.2,459.2)ng/ml 比273.4(177.6,368.6)ng/ml，Z=-3.600， P＜0.001]。女性PD患者血清CHI3L1与AAC评分呈正相关(r=0.590,P＜0.001)；男性PD患者血清CHI3L1与AAC评分相关性不显著(r=0.194,P=0.155)。多元Logistic 回归分析提示血清CHI3L1 (OR=1.012,95% CI：1.005～1.019,P=0.001)、血磷＞1.45mmol/L(OR=5.596,95% CI：1.345～23.278；P=0.018)是女性PD患者AAC评分≥4的独立影响因素；年龄(OR=1.138,95% CI：1.026～1.262,P=0.014)、舒张压(OR=0.927,95% CI：0.861～0.997, P= 0.042)、血清超敏C 反应蛋白(OR=1.169,95% CI：1.003～1.361； P=0.046)及骨骼肌含量(OR=0.829,95% CI：0.696～0.987, P= 0.035)是男性PD 患者AAC 评分≥4 的独立影响因素。结论高水平血清CHI3L1与女性PD患者AAC独立相关，但不是男性PD患者AAC的独立影响因素。

关键词: 壳多糖酶3样蛋白1, 腹膜透析, 血管钙化, 体成分

Abstract: 【Abstract】Objective To investigate the association between serum chitinase-3-like protein 1(CHI3L1) and vascular calcification in peritoneal dialysis (PD) patients of different genders. Methods In this cross-sectional study, a total of 116 patients with chronic renal failure treated with PD over 6 months were recruited. Lateral plain X-ray films of abdomen were used to evaluate the abdominal aortic calcification (AAC) score according to the Kauppila scoring system. Patients were divided into the low AAC score group (AAC score＜4) and the high AAC score group (AAC score≥4). Demographic data and laboratory measurements were collected. Bioelectrical impedance analysis was applied to examine the body composition of these PD patients. Serum CHI3L1 was measured by enzyme-linked immunosorbent assay. Results Fifty- six males and 60 females were recruited. The mean age was 57.0±13.7 years and 61 patients (52.6%) had an AAC score≥4. Serum CHI3L1 of the female patients was significantly higher than that of the male patients (Z=− 3.435，P=0.001). Among male patients, there was a trend that serum CHI3L1 of the high AAC score group was higher than that of the low AAC score group, but the result was not significant (285.9±100.3ng/ml versus. 238.4±106.8ng/ml，t=−1.701,P=0.095). Among female patients, serum CHI3L1 of the high AAC score group was significantly higher than that of the low AAC score group [437.7(314.2,459.2) ng/ml versus. 273.4 (177.6,368.6)ng/ml，Z=−3.600，P＜0.001]. Serum CHI3L1 was positively correlated with the AAC score in the female patients (r=0.590, P＜0.001), but not in the male patients (r=0.194, P=0.155). Multivariate logistic regression analysis showed that serum CHI3L1 (OR=1.012, 95% CI 1.005～1.019, P=0.001) and serum phosphate (＞1.45mmol/L or not) (OR=5.596, 95%CI 1 .345～23.278, P=0.018) were independent related factors of high AAC score (AAC score ≥4) in the female patients. However, age (OR=1.138, 95% CI 1.026～1.262, P=
0.014), diastolic blood pressure (OR=0.927, 95%CI 0.861～0.997, P=0.042), serum high-sensitivity C-reactive protein (OR=1.169, 95%CI 1.003～1.361, P=0.046), and skeletal muscle mass (OR=0.829, 95% CI 0.696～0.987, P=0.035) were the independent related factors of high AAC score (AAC score ≥4) in the male patients. Conclusions There are gender differences in the correlation between serum CHI3L1 and AAC among PD patients. Higher serumCHI3L1 is an independent marker of AAC score in female but not male PD patients.

Key words: chitinase-3-like protein 1, Peritoneal dialysis, Vascular calcification, Body composition

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