中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (02): 103-107.doi: 10.3969/j.issn.1671-4091.2020.02.009

• 临床研究 • 上一篇    下一篇

维持性血液透析患者骨硬化蛋白水平与血管钙化的相关性分析

曹倩颖1,周晶晶1,刘小菁1,金立群1,连晓英1,李忠心1   

  1. 1. 首都医科大学附属北京潞河医院肾病中心
  • 收稿日期:2019-04-22 修回日期:2019-12-30 出版日期:2020-02-20 发布日期:2020-02-12
  • 通讯作者: 李忠心13621211613@139.com E-mail:13621211613@139.com

Correlation between serum Sclerostin level and vascular calcification in maintenance hemodialysis patients

  1. 1Department of Nephrology, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China.
  • Received:2019-04-22 Revised:2019-12-30 Online:2020-02-20 Published:2020-02-12

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摘要： 【摘要】目的探讨血清骨硬化蛋白(Sclerostin)与维持性血液透析(maintenance hemodialysis，MHD)患者腹主动脉钙化之间的关系。方法选择首都医科大学附属北京潞河医院肾病中心150 名维持性血液透析为研究对象，收集患者的人口统计学资料及临床资料，包括有无糖尿病及残余尿量的统计，尿量＜200ml 则视为无残余肾功能(residual renal function，RRF)。同时用酶联免疫吸附法(ELISA)检测血清Sclerostin、骨特异碱性磷酸酶(bone specific alkaline phosphatase，BsAP)。通过腹部侧位X 线片检测腹主动脉钙化(calcification of abdominal aorta，AAC)。分析Sclerostin 水平与MHD 患者iPTH、BsAP、腹主动脉钙化的相关关系。结果①首都医科大学附属北京潞河医院MHD 患者腹主动脉钙化的发生率为74%，按照有无AAC 将患者分为钙化组和无钙化组，结果显示钙化组Sclerostin、Kt/V 明显低于无钙化组(t 值分别为6.694，2.298; P 值分别为＜0.001,0.023)，而年龄、透析龄、iPTH、血清碱性磷酸酶、BsAP 均高于无钙化组(t 值分别为-5.250，-4.356，-2.926，-3.877，-4.654；P 值分别为＜0.001，＜0.001，＜0.001，＜0.001，＜0.001)，两组间性别、血钙、血磷等指标无统计学差异(t 值分别为2.345，-0.262，0.096；P 值分别为0.126，0.794，0.923)。②Logistic 回归分析MHD 患者血管钙化的危险因素：年龄(OR=1.134，95% CI 1.059～1.224，P＜0.001)、透析龄(OR=1.006，95% CI1.006～1.075，P=0.019)、有无残肾(OR=0.150，95% CI 0.027～0.818，P=0.028)、有无糖尿病(OR= 8.199，95% CI1.316～51.073，P=0.024)、iPTH(OR=1.009，95% CI 1.001～1.017，P=0.035)、Kt/V(OR=0.030，95% CI0.001～0.652，P=0.026)、Sclerostin(OR=0.985，95% CI 0.976～0.994，P=0.002)、BsAP(OR=1.295，95%CI 1.037～1.618，P=0.023)均有统计学意义。结论MHD 患者血管钙化发生率高，高龄、透析龄长、糖尿病、高iPTH、高BsAP 均为MHD 患者血管钙化的危险因素，而有残余肾功能、Sclerostin、Kt/V 是MHD 患者血管钙化的保护因素。

关键词: 骨硬化蛋白, 维持性血液透析, 血管钙化, 骨代谢紊乱

Abstract: 【Abstract】Objective To investigate the relationship between serum sclerostin and the degree of abdominal aortic calcification in patients undergoing maintenance hemodialysis(MHD). Methods 150 MHD patients in our hospital's nephropathy center were selected as subjects, Collect patient demographic data and clinical data, Including diabetes and residual urine volume, urine volume <200ml is considered as no residual renal function (RRF), Serum Sclerostin and bone specific alkalinephosphatase(BsAP) levels from 150 cases of MHD patients were measured by ELISA. Abdominal aortic calcification (AAC) was detected by lateral radiographs of the abdomen and AAC scores were performed. Analysis of the relationship between Sclerostin level and iPTH, BsAP and a AAC in patients with MHD. Results 1. The incidence of abdominal aortic calcification in patients with MHD was 74%. The patients were divided into calcified group and non-calcified group according to the presence or absence of AAC. The results showed that the sclerostin, kt/v in the calcified group was significantly lower than that in the non- calcified group (t=6.694, P<0.001). Age（t=- 5.250，P<0.001）, dialysis age (t=-4.356，P<0.001), iPTH(t=-2.926，P<0.001), serum alkaline phosphatase (t=-3.877，P<0.001), BsAP (t=-4.654，P<0.001)were higher than those without calcification (P<0.05). There were no significant differences in gender (t=2.345，P=0.126), serum calcium (t=- 0.262，P=0.794) and phosphorus (t= 0.096，P=0.923) between the two groups (P＞ 0.05). 2. Logistic regression analysis of risk factors for vascular calcification in patients with MHD: Age (OR=1.134, 95% CI, 1.059～1.224, P<0.001), dialysis age (OR=1.006, 95% CI, 1.006- 1.075, P= 0.019), RRF(OR=0.150, 95%CI, 0.027～0.818, P=0.028), Diabetes (OR=8.199, 95% CI, 1.316～51.073, P=0.024), iPTH (OR= 1.009, 95% CI, 1.001～1.017,P=0.035) , Kt/V(OR=0.030, 95% CI, 0.001～0.652, P=0.026), Sclerostin (OR=0.985, 95% CI, 0.976～0.994, P=0.002), BsAP(OR=1.295, 95% CI) , 1.037～1.618, P=0.023) were statistically significant. Conclusion The incidence of vascular calcification were higher in MHD patients.Agedness,Long-dialysis, diabetes, higher iPTH, and higher BsAP are risk factors for vascular calcification in patients with MHD,but RRF, Sclerostin, and Kt/V are protective
factors for vascular calcification in patients with MHD.

Key words: Sclerostin, Maintenance hemodialysis, Vascular calcification, Bone metabolism disorder

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