终末期肾脏病患者血清骨硬化蛋白与血管钙化关系及相关因素分析.docVIP

终末期肾脏病患者血清骨硬化蛋白与血管钙化关系及相关因素分析 　　摘要：目的探讨终末期肾脏病（end-stage renal disease, ESRD）患者血清骨硬化蛋白水平与血管钙化间的关系并分析骨硬化蛋白的影响因素。方法①收集我院长期规律血液净化的ESRD患者100例并按年龄匹配的方式选取正常对照组100例，比较两组间瓣膜钙化发生率、血管钙化积分及血清骨硬化蛋白水平等相关指标的差异，其中血管钙化积分用多层螺旋CT（MSCT）评估，骨硬化蛋白水平用ELISA方法测定。②按骨硬化蛋白中位数将ESRD患者分成两组，比较两组间年龄、性别、高血压及糖尿病发病率、体质指数（BMI）、白蛋白、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、超敏C反应蛋白（hsCRP）、载脂蛋白（α）（apo(α)）、瓣膜钙化发生率、全段甲状旁腺素（iPTH）、降钙素、血钙、血磷、血钙磷乘积、血镁和血管钙化积分等指标的差异并分析血清骨硬化蛋白的影响因素。③采用SPSS 19.0进行统计学分析，P＜0.05为差异有统计学意义。结果ESRD患者血管钙化程度重，血清骨硬化蛋白水平明显升高，其中血清骨硬化蛋白水平较低组的ESRD患者其平均年龄、高血压及糖尿病发病率、透析时间、TC、LDL-C、hsCRP、apo(α)、iPTH、血钙、血磷、血钙磷乘积及血管钙化积分均高于血清骨硬化蛋白较高组的ESRD患者，而白蛋白和血镁水平均低于后者，差异有统计学意义。同时血清骨硬化蛋白水平与年龄、白蛋白、血清甲状旁腺激素水平、血磷、钙磷乘积及血管钙化积分呈负相关，与血镁水平正相关。结论血管钙化在ESRD患者中普遍存在，且程度较重。ESRD患者骨硬化蛋白水平明显升高，且与年龄、白蛋白、甲状旁腺素、血磷、钙磷乘积、瓣膜钙化及血管钙化呈负相关，提示其可作为一个新的反应ESRD患者骨转化水平和血管钙化程度的指标，但其临床意义还需进一步研究。 　　关键词：终末期肾脏病；血管钙化；骨硬化蛋白 　　Relationship between Serum Sclerostin Level and Vascular Calcification in Esrd Patients and the Analysis of Their Relative Factors 　　GAN Yu-zhou, GAN Hua 　　(Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016,China) 　　Abstract：ObjectiveTo explore the relationship between serum sclerostin level and vascular calcification in ESRD patients and to observe the effect factors of sclerostin. Methods1. A cross-sectional study was performed in 100 ESRD patients and 100 people in controlled group with matched age, data was documented of BMI, Albumin, TC, TG, LDL-C, HDL-C, hsCRP, Lp(α), valve calcification, iPTH, calcitonin, Ca, P, Ca×P, Mg, and vascular calcification score and serum sclerostin level. Besides, the vascular calcification score was quantitively evaluated by MSCT and the sclerostin level was examined by ELISA. 2. Divide the ESRD patients into two groups according to the sclerostin median level and compare the difference of age, sex, prevalence of hypertension and diabetes, TC, TG, LDL-C, HDL-C, hsCRP, the prevalence of valve calcification, iPTH, calcitonin, Ca, P, Ca