摘要
目的观察尿毒症患者血管钙化(vascular calcification,VC)与骨硬化蛋白(Sclerostin)水平之间的相关性。方法采用ELISA方法检测56例行动静脉内瘘(arteriovenous fistula,AVF)成形术患者、56例行维持性血液透析(maintenance hemodialysis,MHD)治疗患者和56例健康人群的血清Sclerostin水平;收集研究对象基本资料及生化指标;腹部CT评估腹主动脉钙化发生情况;苏木精-伊红(hematoxylin-eosin,HE)染色及茜素红染色观察桡动脉钙化情况。结果3组对比发现AVF组及MHD组患者的VC发生率(F=29.973,P<0.001)、磷(F=45.308,P<0.001)、镁(F=42.468,P<0.001)、尿酸(F=16.049,P<0.001)、碱性磷酸酶(F=5.677,P=0.005)、三酰甘油(F=5.521,P=0.005)、全段甲状旁腺激素(F=22.001,P<0.001)、Sclerostin(F=202.458,P<0.001)水平高于对照组;钙(F=15.006,P<0.001)、25羟维生素D水平(F=9.904,P<0.001)低于对照组。AVF组内桡动脉钙化组患者年龄(t=2.033,P=0.048)、磷(t=4.170,P<0.001)、全段甲状旁腺激素(t=-2.374,P=0.018)、Sclerostin(t=9.709,P<0.001)水平高于非钙化组。MHD组中腹主动脉钙化组年龄(t=2.033,P=0.048)、磷(t=2.360,P=0.023)、碱性磷酸酶(t=2.122,P=0.040)、全段甲状旁腺激素(t=2.130,P=0.039)、Sclerostin(t=2.671,P=0.011)水平高于非钙化组。受试者特征工作曲线(receiver operating curve,ROC)分析,血清Sclerostin预测AVF组及MHD组患者VC的曲线下面积分别为0.895(95%CI为0.815~0.976,P<0.001,最佳截断值为5.55ng/ml,灵敏度为82.4%,特异度为86.4%)、0.746(95%CI为0.593~0.898,P=0.007,最佳截断值为6.8555ng/ml,灵敏度为71.4%,特异度为81.2%)。结论VC与年龄、磷、全段甲状旁腺激素、血清Sclerostin水平呈正相关。
Objective To observe the correlation between vascular calcification(VC)and serum sclerostin level in uremia patients.Method Serum sclerostin levels were detected by ELISA in 56 patients who underwent arteriovenous fistula operation(AVF group),56 maintenance hemodialysis patients(MHD group),and 56 normal individuals(control group).Their demographic data and biochemical indicators were collected.Abdominal CT was used to evaluate abdominal aortic calcification.Hematoxylin-eosin(HE)staining and alizarin red staining were used to examine the calcification of the radial artery in surgical samples.Result VC rate(F=29.973,P<0.001),serum phosphorus(F=45.308,P<0.001),magnesium(F=42.468,P<0.001),uric acid(F=16.049,P<0.001),alkaline phosphatase(F=5.677,P=0.005),triglyceride(F=5.521,P=0.005),immunoreactive parathyroid hormone(F=22.001,P<0.001)and serum sclerostin(F=202.458,P<0.001)were significantly higher in AVF and MHD groups than in control group.Serum calcium(F=15.006,P<0.001)and 25-OH-vitamin D(F=9.904,P=0.000)were lower in AVF and MHD groups than in control group.In AVF group,patients with radial artery calcification had older age(t=2.033,P=0.048),and higher serum phosphorus(t=4.170,P<0.001),immunoreactive parathyroid hormone(t=-2.374,P=0.018)and serum sclerostin(t=9.709,P<0.001)than those without radial artery calcification.In MHD group,patients with abdominal aortic calcification had older age(t=2.033,P=0.048),and higher levels of phosphorus(t=2.360,P=0.023),alkaline phosphatase(t=2.122,P=0.040),immunoreactive parathyroid hormone(t=2.130,P=0.039)and serum sclerostin(t=2.671,P=0.011)than those without abdominal aortic calcification.ROC curve analysis showed that the area under the curve of serum sclerostin for prediction of VC in AVF group was 0.895(95%CI 0.815~0.976,P<0.001);at the optimal cut-off value of serum sclerostin 5.55ng/ml,the sensitivity of for the diagnosis of VC was 82.4%,the specificity was 86.4%.The area under the curve of serum sclerostin for prediction of abdominal aortic calcification in MHD group wa
作者
彭琼瑶
谢树钦
马宁
刘玲
PENG Qiong-yao;XIE Shu-qin;MA Ning;LIU Ling(Department of Nephrology,The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)
出处
《中国血液净化》
CSCD
2020年第5期289-293,共5页
Chinese Journal of Blood Purification
关键词
骨硬化蛋白
血管钙化
慢性肾脏病5期
尿毒症
Sclerostin
Vascular calcification
Stage 5 chronic kidney disease
Uremia
