维持性血液透析患者血清骨硬化蛋白与颈动脉内膜中层厚度的关系*

Relationship between serum sclerostin and carotid intima-media thickness in maintenance hemodialysis patients*

摘要:

目的 了解维持性血液透析患者骨硬化蛋白水平与动脉硬化间的关系。方法 收集75例维持性血液透析患者每周第1次血液透析前的血液标本，检测血清全段甲状旁腺激素（iPTH）、骨硬化蛋白水平，同时B超测定颈动脉内膜中层厚度（IMT），所有患者以血清骨硬化蛋白平均值152.34?pmol/L为界，分为低骨硬化蛋白组及高骨硬化蛋白组，比较两组患者颈动脉IMT及相关指标，对颈动脉IMT与骨硬化蛋白水平及相关因素间进行相关性分析、回归分析。结果 与高骨硬化蛋白组比较，低骨硬化蛋白组患者颈动脉IMT、血清iPTH及碱性磷酸酶（ALP）水平均升高（P?<0.05），颈动脉IMT与骨硬化蛋白呈负相关（r?=-0.738，P?=0.000），与iPTH呈正相关（r?=0.382，P?=0.001）。骨硬化蛋白与iPTH及ALP水平呈负相关（r?=-0.420和-0.285，P?= 0.000和0.013）。Logistic回归分析显示，血清骨硬化蛋白水平是颈动脉IMT的影响因素[OlR=0.92，（95% CI： 0.88，0.97）]。结论 在维持性血液透析患者中，颈动脉IMT与血清骨硬化蛋白水平呈负相关，较低的骨硬化蛋白水平提示患者动脉硬化较重。

Abstract:

Objective To evaluate the relationship between serum sclerostin and arteriosclerosis in maintenance hemodialysis patients. Methods Serum samples from 75 maintenance hemodialysis patients were collected at the time of first hemodialysis every week. The serum levels of intact parathyroid hormone (iPTH) and sclerostin were measured. Carotid intima-Media thickness (IMT) was measured by ultrasound. All patients were divided into low sclerostin group and high sclerostin group with the average value of 152.34?pmol/L. The carotid IMT and related indicators were compared between the two groups. The correlation between carotid IMT and sclerostin level and related factors was analyzed by regression analysis. Results Research showed that the patients with low sclerostin level had higher carotid IMT than patients with high sclerostin level (P?=?0.000). Carotid IMT was negatively correlated with serum sclerostin level (r?=?-0.738, P?=?0.000), and correlated with serum iPTH levels (r?=?0.382, P?=?0.001). Serum sclerostin level was negatively correlated with iPTH and ALP levels (r?=?-0.420 and -0.285, P?=?0.000 and 0.013). Multi factor line Logistic regression showed that the sclerostin level was a independent influencing factors for the carotid IMT [OlR=?0.92, (95% CI: 0.88, 0.97)]. Conclusions In patients with maintenance hemodialysis, carotid IMT is negatively correlated with serum sclerostin level. Low serum sclerostin level suggests severe atherosclerosis.