中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (12): 793-797.doi: 10.3969/j.issn.1671-4091.2017.012.001

• 临床研究 •    下一篇

维持性血液透析患者血清Sclerostin 与血管钙化相关性分析

吴雪莹1,张琢1,徐天华1,杜银科1,王力宁1,姚丽1   

  1. 1.  中国医科大学附属第一医院肾脏内科
  • 收稿日期:2017-07-24 修回日期:2017-10-02 出版日期:2017-12-12 发布日期:2017-12-18
  • 通讯作者: 姚丽:liyao_cmu@163.com E-mail:1017471908@qq.com
  • 基金资助:

    国家重点研发计划“全国罕见病队列研究”(2016YFC0901501); 辽宁省自然科学基金“MicroRNA-30b调控自噬在慢性肾脏病血管钙化的作用及机制研究”(20170540999); 沈阳市科学技术计划项目“Sclerostin/Lrp4 调节VSMC成骨分化影响CKD 血管钙化的机制研究”(F16-206-9-04)

The correlation analysis of serum sclerostin and vascular calcification in maintenance hemodialysis patients

  • Received:2017-07-24 Revised:2017-10-02 Online:2017-12-12 Published:2017-12-18

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摘要： 目的 观察维持性血液透析(maintenance hemodialysis，MHD)患者血管钙化发生情况，探讨MHD 患者血清骨硬化蛋白(Sclerostin)与血管钙化的关系。方法  选取2015 年6 月～2016 年6 月于中国医科大学附属第一医院MHD 患者30 例为实验组，选取健康对照组30 例，腹部侧位X 线片评估腹主动脉钙化，检测血清Sclerostin、钙、磷、全段甲状旁腺激素、镁、25 羟维生素D、血清白蛋白(albumin, ALB)等指标。结果 实验组与对照组血管钙化发生率有明显差异 (χ2=9.317, P= 0.005),2 组血管钙化积分也有明显差异(t=2.330,P=0.023)，实验组Sclerostin 水平是对照组Sclerostin 水平的3～4 倍[(4.81±1.18)ng/ml 比(1.25±0.61)ng/ml，t=14.162，P＜0.001]。MHD 患者血管钙化组的Sclerostin 水平低于非血管钙化组(t=2.697，P=0.012)，Spearman 相关分析MHD 患者血管钙化与血清Sclerostin 水平呈负相关(r=- 0.500,P=0.005)，与年龄(r=0.588,P=0.001)、透析龄(r=0.417,P=0.022)、磷(r=0.741,P＜0.001)、钙磷乘积(r=0.612,P＜0.001)、全段甲状旁腺激素(r=0.588,P=0.001)、镁(r=0.470,P=0.009)等指标呈正相关。Sclerostin 水平较高组的血管钙化积分低于Sclerostin 水平较低组(t=-2.324,P=0.026)。ROC 曲线分析，Sclerostin 预测血管钙化的曲线下面积为0.707(95% CI 0.579～0.834，P=0.020)，最佳截断值2.03ng/ml，灵敏度100%，特异度60.9%。结论MHD 患者血管钙化发生率高、程度重，血管钙化与血清Sclerostin 水平负相关，与年龄、透析龄、血磷、钙磷乘积、血清全段甲状旁腺激素、血镁等指标正相关。血清Sclerostin可能是一种血管钙化的保护因素，对预测血管钙化有重要作用。

关键词: 骨硬化蛋白, 血管钙化, 维持性血液透析, 终末期肾脏病

Abstract: Objective To observe the incidence of vascular calcification and to analyze the relationship between serum sclerostin and vascular calcification in maintenance hemodialysis (MHD) patients. Methods A total of 30 cases on long-term MHD treated from June 2015 to June 2016 in the First Affiliated Hospital of China Medical University were recruited as the experiment group; 30 normal individuals were selected as the control group. Their abdominal aorta calcification was evaluated by abdominal X-ray. Serum sclerostin, calcium, phosphorus, immunoreactive parathyroid hormone (iPTH), magnesium, 25- hydroxyvitamin D, albumin and other indices were recorded. Results Vascular calcification rate was significant different between experiment group and control group (χ2=9.317, P=0.005), and so did the vascular calcification score (t=2.330, P=0.023). Serum sclerostin was 3- 4 times higher in experiment group than in control group (t=14.162, P＜0.001). In experiment group, serum sclerostin level was lower in the MHD patient with vascular calcification than those without vascular calcification (t=2.697, P=0.012). Spearman correlation analysis showed that vascular calcification in MHD patients was negatively correlated with sclerostin level (r=-0.500, P=0.005), and was positively correlated with age (r=0.588, P=0.001), dialysis age (r=0.417, P=0.022), phosphorus (r=0.741, P＜0.001), calcium and phosphorus product (r=0.612, P＜0.001), total parathyroid hormone (r=0.588, P=0.001) and magnesium (r=0.470,P=0.009). Vascular calcification score was lower in MHD patients with higher serum sclerostin than in those with lower serum sclerostin (t=- 2.324, P =0.026). ROC curve analysis showed that the area under the curve of serum Sclerostin for prediction of vascular calcification was 0.707(95% CI: 0.579～0.834, P=0.020) with the optimal cut-off value of 2.03 ng/mL, the sensitivity of 100% and specificity of 60.9%. Conclusion The incidence and the degree of vascular calcification were higher in MHD patients. Vascular calcification was negatively correlated with serum sclerostin level, and positively correlated with age, dialysis age, phosphorus, calcium and phosphorus product, iPTH and magnesium. Serum sclerostin may be a protective factor for vascular calcification and a relatively accurate marker for the prediction of vascular calcification.

Key words: Sclerostin, Vascular calcification, Maintenance hemodialysis, End-stage renal disease.