腹主动脉钙化患者AAC评分与TGF-β1、MCP-1、骨密度的关系

Association of AAC score with TGF-β1, MCP-1 and bone mineral density in patients with abdominal aortic calcification

摘要:

目的 探讨腹主动脉钙化（AAC）患者血管钙化程度与转化生长因子β₁（TGF-β₁）、单核细胞趋化蛋白1（MCP-1）水平、骨密度的相关性。方法 前瞻性选取2021年5月—2022年3月石河子大学医学院第一附属医院收治的401例AAC患者。依据AAC评分将患者分为无钙化组、轻度钙化组、中度钙化组及重度钙化组，分别有107、107、98和89例。双能X射线检测骨密度T值，酶联免疫吸附试验检测血浆中TGF-β₁和MCP-1表达，分析AAC评分与TGF-β₁、MCP-1水平及骨密度T值的相关性。结果 轻度钙化组、中度钙化组、重度钙化组年龄高于无钙化组（P <0.05）；无钙化组、轻度钙化组体质量指数高于重度钙化组（P <0.05），无钙化组与轻度钙化组、中度钙化组体质量指数比较，差异无统计学意义（P >0.05）；中度钙化组、重度钙化组高血压、冠心病患病率高于无钙化组（P <0.05），无钙化组与轻度钙化组高血压、冠心病患病率比较，差异无统计学意义（P >0.05）。轻度钙化组、中度钙化组、重度钙化组TGF-β₁高于无钙化组（P <0.05），重度钙化组高于轻度钙化组、中度钙化组（P <0.05）；轻度钙化组、中度钙化组、重度钙化组MCP-1高于无钙化组（P <0.05），中度钙化组高于轻度钙化组（P <0.05），轻度钙化组与重度钙化组MCP-1比较，差异无统计学意义（P >0.05）；轻度钙化组、中度钙化组、重度钙化组骨密度异常检出率高于A组（45.8%）（P <0.05），中度钙化组、重度钙化组高于轻度钙化组。有序多分类Logistic回归分析结果显示：年龄、有高血压、骨密度T值降低是影响血管钙化的危险因素（P <0.05）。Pearson分析结果显示：AAC评分与TGF-β₁、MCP-1、年龄呈正相关（r =0.245、0.126和0.651，均P <0.05），与骨密度T值、BMI、呈负相关（r =-0.385和-0.168，均P <0.05），与碱性磷酸酶、血钙、血磷、白蛋白无相关性（r =0.065、0.008、-0.071和0.053，均P >0.05）。结论 低骨密度、高龄、血浆TGF-β₁、MCP-1水平升高有可能作为血管钙化的危险因素，可一定程度上预测血管钙化的风险。

Abstract:

Objective To investigate the association of the degree of vascular calcification with the levels of transforming growth factor-β₁ (TGF-β₁) and monocyte chemoattractant protein-1 (MCP-1) and bone mineral density (BMD) in patients with abdominal aortic calcification (AAC).Methods A total of 401 AAC patients admitted to the First Affiliated Hospital of the Medical College, Shihezi University from May 2021 to March 2022 were prospectively selected. According to the AAC score, the patients were divided into non-calcification group (107 cases), mild calcification group (107 cases), moderate calcification group (98 cases) and severe calcification group (89 cases). The T-score of BMD was measured via dual-energy X-ray absorptiometry, and the plasma levels of TGF-β1 and MCP-1 were measured by enzyme-linked immunosorbent assay (ELISA). The correlations of AAC scores with levels of TGF-β₁ and MCP-1 and T-scores were analyzed.Results The age of patients in the mild calcification group, moderate calcification group and severe calcification group was higher than that in the non-calcification group (P < 0.05). The body mass index of patients in the non-calcification group and the mild calcification group was higher than that in the severe calcification group (P < 0.05), while there was no difference in the body mass index among patients in the non-calcification group, mild calcification group and moderate calcification group (P > 0.05). The prevalence of hypertension and that of coronary heart disease in the moderate calcification group and severe calcification group were higher than those in the non-calcification group (P < 0.05), whereas there was no difference in the prevalence of hypertension and that of coronary heart disease between the non-calcification group and the mild calcification group (P > 0.05). The level of TGF-β₁ in the mild calcification group, the moderate calcification group and the severe calcification group was higher than that in the non-calcification group (P < 0.05), while that in the severe calcification group was even higher relative to that in the mild calcification group and the moderate calcification group (P < 0.05). The level of MCP-1 in the mild calcification group, the moderate calcification group and the severe calcification group was higher than that in the non-calcification group (P < 0.05), while that in the moderate calcification group was even higher than that in the mild calcification group (P < 0.05). In contrast, the level of MCP-1 was not different between the mild calcification group and the severe calcification group (P > 0.05). The frequency of abnormal BMD in the mild calcification group, the moderate calcification group and the severe calcification group was higher than that in the non-calcification group (P < 0.05), and that in the moderate calcification group and the severe calcification group was even higher compared with the mild calcification group (P < 0.05). The ordinal Logistic regression analysis revealed that advanced age, the presence of hypertension and lower BMD were risk factors for vascular calcification (P < 0.05). The Pearson correlation analysis demonstrated that the AAC score was positively correlated with the levels of TGF-β₁ and MCP-1 and age (r = 0.245, 0.126 and 0.651, all P < 0.05), but was negatively correlated with the T-score of BMD and body mass index (r = -0.385 and -0.168, both P < 0.05). However, the AAC score was not correlated with the levels of alkaline phosphatase, blood calcium, blood phosphorus and albumin (r = 0.065, 0.008, -0.071 and 0.053, all P > 0.05).Conclusions Low BMD, advanced age, and elevated plasma levels of TGF-β₁ and MCP-1 may be risk factors for AAC and predict the risk of AAC to a certain extent.