中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (12): 988-992.doi: 10.3969/j.issn.1671-4091.2025.12.005

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血清钙蛋白颗粒、可溶性Klotho蛋白、生长分化因子11与冠状动脉钙化及心血管事件的关系

郭媛媛   秦俊红   袁丽丽   

  1. 057150 邯郸，邯郸市中心医院1老年病一科 2血液净化科
  • 收稿日期:2025-03-24 修回日期:2025-09-25 出版日期:2025-12-12 发布日期:2025-12-12
  • 通讯作者: 郭媛媛 E-mail:yb13am@163.com

Association of serum CPPs, Klotho, GDF11 with coronary artery calcification and cardiovascular events in maintenance hemodialysis patients

GUO Yuan-yuan, QIN Jun-hong, YUAN Li-li   

  1. Department of Geriatrics I, 2Department of Hemodialysis, Handan Central Hospital, Handan 057150, China
  • Received:2025-03-24 Revised:2025-09-25 Online:2025-12-12 Published:2025-12-12
  • Contact: 057150 邯郸，邯郸市中心医院1老年病一科 E-mail:yb13am@163.com

摘要： 目的  探讨维持性血液透析(maintenance hemodialysis，MHD)患者血清钙蛋白颗粒(calciprotein particles，CPPs)、可溶性Klotho蛋白、生长分化因子11(growth differentiation factor 11，GDF11)与冠状动脉钙化及主要不良心血管事件(major adverse cardiovascular events，MACE)的关系。 方法  选取2022年1月─2023年6月在邯郸市中心医院进行MHD的患者179例。ELISA法检测血清CPPs、Klotho、GDF11表达水平；应用Pearson相关性分析、Kaplan-Meier生存曲线、COX回归及ROC曲线进行分析。  结果  钙化组(n=115)血清CPPs水平高于无钙化组(n=64)(t=3.949，P=0.001)，Klotho、GDF11水平低于无钙化组(t=6.327、6.378，均P＜0.001)； CPPs低表达组(n=86)1年MACE发生率低于高表达组(n=93)(χ2=27.225，P＜0.001)；Klotho低表达组(n=91)、GDF11低表达组(n=97)1年MACE发生率高于Klotho高表达组(n=88)、GDF11高表达组(n=82)(χ2=35.554、37.789，P=0.005、0.005)；MACE组(n=76)患者年龄、透析龄、CACs、CPPs高于非MACE组(n=10S3)(t/χ2=3.426、4.351、27.351、8.117，均P＜0.001)，Klotho、GDF11均低于非MACE组(t=7.247、7.031，均P＜0.001)；CPPs与CACs呈正相关(r=0.472，P＜0.001)，Klotho、GDF11与CACs均呈负相关(r=-0.384、-0.417，均P＜0.001)；年龄大(HR=2.317，95% CI：1.140～4.710，P＜0.001)、CACs(HR=2.031，95% CI：1.307～3.157，P＜0.001)及CPPs(HR=1.549，95% CI：1.191～2.014，P＜0.001)升高是发生MACE危险因素，Klotho(HR=0.614，95% CI：0.409～0.921，P＜0.001)、GDF11(HR =0.762，95% CI：0.623～0.932，P＜0.001)水平升高是保护因素；CPPs、Klotho、GDF11三者联合预测MACEAUC为0.919，优于各自单独预测(Z=3.911、2.819、3.831，P＜0.001、0.005、＜0.001)。 结论 MHD患者血清CPPs升高、Klotho和GDF11降低与冠状动脉钙化及MACE密切相关，三者联合检测可作为预测MACE的重要指标。

关键词: 维持性血液透析, 钙蛋白颗粒, 可溶性Klotho蛋白, 生长分化因子11

Abstract: Objective  To investigate the association of serum calciprotein particles (CPPs), soluble Klotho protein, and growth differentiation factor 11 (GDF11) with coronary artery calcification (CAC) and major adverse cardiovascular events (MACE) in patients undergoing maintenance hemodialysis (MHD).  Methods  A total of 179 MHD patients treated at Handan Central Hospital between January 2022 and June 2023 were enrolled. Serum levels of CPPs, Klotho, and GDF11 were measured by ELISA. Pearson correlation analysis, Kaplan-Meier survival curves, COX regression, and ROC curves were used for analysis.  Results  Compared with the non-calcification group (n=64), patients in the calcification group (n=115) had increased serum CPPs levels (t=3.949, P=0.001) and decreased levels of Klotho and GDF11 (t=6.327, 6.378, P<0.001). The 1-year MACE incidence in the low CPPs expression group (n=86) was lower than that in the high CPPs expression group (n=93) (χ2=27.225, P<0.001). The 1-year MACE incidence in the low Klotho and GDF11 expression groups (n=91, 97) was higher than that in the high Klotho and GDF11 expression groups (n=88, 82) (χ2=35.554, 37.789, P=0.005, 0.005). Patients in the MACE group (n=76) had higher age, dialysis vintage, CACs, and CPPs than those in the non-MACE group (n=103) (t/χ2=3.426, 4.351, 27.351, 8.117, P<0.001), and lower Klotho and GDF11 levels (t=7.247, 7.031, P<0.001). CPP levels showed a positive correlation with CACs (r=0.472, P<0.001), while Klotho and GDF11 levels both exhibited a negative correlation with CACs (r=-0.384 and -0.417, respectively, both P<0.001). Advanced age (HR=2.317, 95%CI=1.140～4.710), higher CACs (HR=2.031, 95%CI=1.307～3.157), and elevated CPPs (HR=1.549, 95%CI=1.191～2.014) were risk factors for MACE in MHD patients. Elevated Klotho (HR=0.614, 95%CI=0.409～0.921), GDF11 (HR=0.762, 95%CI=0.623～0.932) levels were protective factors (P<0.001). The AUC of the combined prediction of CPPs, Klotho, and GDF11 for MACE in MHD patients was 0.919, which was superior to their individual predictions (Z=3.911, 2.819, 3.831, P=0.000, 0.005, 0.000).  Conclusion  Elevated serum CPPs and reduced Klotho and GDF11 levels in MHD patients are closely associated with coronary artery calcification and MACE in MHD patients. Combined detection of these three markers may serve as an important indicator for predicting MACE.

Key words: Maintenance hemodialysis, Calciprotein particles, Soluble Klotho protein, Growth differentiation factor 11 

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