中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (08): 594-598.doi: 10.3969/j.issn.1671-4091.2023.08.006

• 临床研究 • 上一篇    下一篇

维持性血液透析患者外周血骨钙素水平与腹主动脉钙化的关系研究

郭 玲  安智峰   宋 杰   

  1. 300162 天津，1武警特色医学中心肾病科
  • 收稿日期:2023-03-29 修回日期:2023-05-17 出版日期:2023-08-12 发布日期:2023-08-12
  • 通讯作者: 宋杰 E-mail:sujl730@163.com
  • 基金资助:
    天津市科技计划项目(15ZXLCSY00040)；武警特色医学中心科研创新团队课题(KYCXTD05)

Relationship between osteocalcin level in peripheral blood and abdominal aortic calcification in maintenance hemodialysis patients

GUO Ling, AN Zhi-feng, SONG Jie   

  1. Department of Nephrology, Characteristic Medical Center of People's Armed Police Force, Tianjin 300162, China
  • Received:2023-03-29 Revised:2023-05-17 Online:2023-08-12 Published:2023-08-12
  • Contact: 300162 天津，1武警特色医学中心肾病科 E-mail:sujl730@163.com

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摘要： 目的 研究维持性血液透析(maintenance hemodialysis,MHD)患者血清骨钙素水平及其与腹主动脉钙化的关系。 方法 采用观察性横断面研究方法，收集2020年1月一2022年12月武警特色医学中心血液净化中心收治的220例MHD患者临床资料。根据Kauppila钙化积分法评价腹主动脉钙化评分(abdominal aortic calcification scores,AACs)分为无或轻度腹主动脉钙化(AACs≤ 4)组(114例)和显著腹主动脉钙化(AACs＞4)组(106例)。使用Pearson相关性分析分析骨钙素与其他影响骨代谢参数相关性。使用多因素Logistic回归分析影响显著腹主动脉钙化发生的独立危险因素。 结果 全部患者的骨钙素水平为231.56(25.92，361.33)ng/ml。根据MHD患者不同年龄分层后，各年龄段的男女患者骨钙素水平均高于参考范围。与显著腹主动脉钙化组相比，无或轻度腹主动脉钙化组的年龄更小(t=9.783，P＜0.001)、透析时间更短(t=1.251，P=0.038)、男性更多(χ2=31.022,P＜0.001)、糖尿病史更少(χ2=119.216,P＜0.001)和血清骨钙素水平更低(t=6.481，P=0.029)。Pearson相关分析显示骨钙素与血清磷(r=0.511，P=0.001)、全段甲状旁腺激素(r =0.594，P=0.001)、成纤维细胞生长因子23(r=0.485，P=0.003)、AACs评分(r=0.413，P=0.0201)呈正相关，与年龄呈负相关(r=-0.356，P=0.039)。多因素Logistic回归分析可见患者的年龄(OR=1.151，95% CI：1.021～1.297，P=0.024)和骨钙素(OR=1.235,95% CI 1.068～1.427，P=0.003)是显著腹主动脉钙化的独立危险因素。 结论  MHD患者骨钙素水平升高，高水平骨钙素是腹主动脉钙化的独立危险因素。

关键词: 维持性血液透析, 终末期肾病, 动脉钙化, 骨钙素

Abstract: Objective To study the relationship between serum osteocalcin level and abdominal aortic calcification in patients with maintenance hemodialysis (MHD).  Methods An observational and cross-sectional study was conducted to collect the clinical data of 220 MHD patients admitted to the Blood Purification Center, Characteristic Medical Center of PAPF from January 2020 to December 2022. Abdominal aortic calcification scores (AACs) were evaluated using the Kauppila Calcification Score method. The patients were then divided into no or mild abdominal aortic calcification group (AACs ≤4, n=114) and significant abdominal aortic calcification group (AACs＞4,n=106). Pearson correlation analysis was used to analyze serum osteocalcin and other parameters affecting bone metabolism. Multivariate logistic regression was used to analyze the independent risk factors for significant abdominal aortic calcification.  Results  The average serum osteocalcin level was 231.56 (25.92, 361.33) ng/ml in the 220 patients. After stratification according to the age of MHD patients, serum osteocalcin was higher than the reference range in both male and female patients of all age groups. Patients in the no or mild abdominal aortic calcification group had the characteristics of younger age (t=9.783, P＜0.001), shorter dialysis age (t=1.251, P=0.038), males more than females (χ2=31.022, P＜0.001), less having diabetes history (χ2=119.216, P＜0.001), and lower serum osteocalcin (t=6.481, P=0.029), as compared those in the significant abdominal aortic calcification group. Pearson correlation analysis showed that serum osteocalcin was positively correlated with serum phosphorus (r=0.511, P=0.001), total parathyroid hormone (r=0.594, P=0.001), FGF23 (r=0.485, P=0.003), and AACs score (r=0.413, P=0.0201), while negatively correlated with age (r=-0.356, P=0.039). Multivariate logistic regression analysis showed that age (OR=1.151, 95% CI 1.021～1.297, P=0.024) and osteocalcin (OR=1.235, 95% CI 1.068～1.427, P=0.003) were the independent risk factors for significant abdominal aortic calcification.  Conclusion  Higher serum osteocalcin was present in MHD patients, and higher serum osteocalcin was an independent risk factor for abdominal aortic calcification.

Key words: Maintenance hemodialysis, End stage renal disease, Arterial calcification, Osteocalcin

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