中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (09): 525-529.doi: 10.3969/j.issn.1671-4091.2015.09.005

• 临床研究 • 上一篇    下一篇

血清可溶性KLOTHO蛋白与腹膜透析患者矿物质骨代谢及腹主动脉钙化相关性的研究

仲思1，2,范秋灵1,卢新星2,苏彦2,张东成2,王力宁1   

  1. 1中国医科大学附属第一医院肾内科
    2辽宁省人民医院肾内科
  • 收稿日期:2015-03-19 修回日期:2015-07-03 出版日期:2015-09-12 发布日期:2015-09-12
  • 通讯作者: 范秋灵 cmufql@163.com E-mail:cmufql@163.com
  • 基金资助:

    国家自然科学基金(81270808)；辽宁省科技厅社会发展攻关计划(2012225019)

Clinical study of the relationship between serum soluble Klotho protein and the abnormalities of mineral-bone metabolism and abdominal aortic calcification in peritoneal dialysis patients

  • Received:2015-03-19 Revised:2015-07-03 Online:2015-09-12 Published:2015-09-12

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摘要： 【摘要】目的探讨血清可溶性Klotho 蛋白(sKL)与持续性非卧床腹膜透析(CAPD)患者矿物质骨代谢指标及腹主动脉钙化的关系。方法58 例接受腹膜透析治疗＞3 个月以上且临床病情稳定的患者被纳入研究范围，收集患者的临床资料和血钙、磷、甲状旁腺激素(iPTH)、25-羟维生素D 等生化指标。用ELISA 法测定血清中可溶性Klotho 蛋白(sKL)、人成纤维生长因子23(FGF23)、人骨特异性碱性磷酸酶(BAP)浓度。应用腹部侧位片评价患者腹主动脉钙化程度，计算腹主动脉钙化积分(AAC)。采用Pearson相关性分析的方法分析sKL 与AAC 及临床指标的关系，用logistic 回归的方法分析CAPD 患者发生腹主动脉钙化的危险因素，受试者工作特征曲线(ROC)评价sKL 诊断腹主动脉钙化的准确性与特异性。结果58 例腹膜透析患者中50 发生腹主动脉钙化，钙化发生率为86.2%，血清sKL 的浓度157.87± 33.49 pg/mL。sKL 浓度与AAC 积分、血磷、FGF23 呈负相关(r 分别为-0.73、-0.26、-0.33，三者均P＜0.05)，与25-羟维生素D 呈正相关(r=0.48，P＜0.05)，与BAP、PTH、血矫正钙无相关性(r 分别为-0.17、-0.23、-0.04，P分别为0.21、0.09、0.75)。多因素Logistic 回归分析结果显示：血清sKL 降低(β=0.038，OR= 0.96，P＜0.05)和FGF23(β=0.08，OR=1.09，P＜0.05)是CAPD 患者腹主动脉钙化的独立危险因素。ROC 曲线下面积(AUC)示sKL 诊断腹主动脉钙化的AUC= 0.81(截点为153.78 pg/mL，准确性为87.5%，特异性58.0%)。结论血清可溶性Klotho 蛋白与腹膜透析患者的矿物质骨代谢异常相关，随着血清可溶性Klotho 蛋白浓度的下降，腹主动脉钙化的风险升高，血清可溶性Klotho蛋白可以作为血管钙化的生物标志物。

关键词: 腹膜透析（CAPD）, 血管钙化, 可溶性Klotho, 人成纤维生长因子23（FGF23）

Abstract: 【Abstract】Objective To assess the relationship between serum soluble Klotho protein (sKL) and the abnormalities of mineral-bone metabolism and abdominal aortic calcification in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods Fifty eight CAPD patients were prospectively studied. Their clinical
data and biochemical indicators including serum calcium, phosphorus, intact parathyroid hormone (iPTH), and 25-hydroxy vitamin D were analyzed. Serum sKL, fibroblast growth factor 23 (FGF23), and bone-specific alkaline phosphatase (BAP) were detected by ELISA. The diagnosis of abdominal aortic calcification was
based on the images on abdomen lateral X-ray plain film, from which the abdominal aortic calcification score (AAC) was calculated. Linear correlation was used to analyze the relationship between sKL and biochemical indicators and AAC. Logistic regression analysis was performed to determine the risk factors for abdominal aortic calcification in CAPD patients. The receiver operating characteristic (ROC) curve was applied to evaluate the diagnostic value of sKL for abdominal aortic calcification. Results Fifty patients (86.2%) had abdominal aortic calcification, and serum sKL was 157.87±33.49 pg/mL. Serum sKL concentration was negatively correlated with AAC, phosphorus, and FGF23 (r=-0.73, P＜0.05; r=-0.26, P＜0.05; r=-0.33, P＜0.05; respectively), positively correlated with 25- hydroxy vitamin D (r=0.48, P＜0.05), but not correlated withBAP, iPTH, and corrected serum calcium (r=-0.17, P=0.21; r=-0.23, P=0.09; r=-0.04, P=0.75; respectively). Multivariate logistic regression analysis showed that lower serum sKL level and FGF23 were the independent risk factors for abdominal aortic calcification. ROC analyses for serum sKL in the diagnosis of abdominal aortic calcification showed that the sensitivity and specificity was 87.5% and 58.0%, respectively, when serum sKL was set at 153.78 pg/ml (AUC=0.91). Conclusions In CAPD patients, serum sKL was correlated with mineral-bone metabolism, and the lower serum sKL was associated with risk of abdominal aorta calcification. Serum sKL may have diagnostic value for abdominal aorta calcification in CAPD patients.

Key words: Continuous ambulatory peritoneal dialysis, angiosteosis, Soluble Klotho, Fibroblast growth factor-23