腹膜透析患者血清可溶性klotho蛋白与腹主动脉钙化的关联性研究

发布时间：2018-06-08 03:00

本文选题：主动脉 + 腹　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:终末期肾脏病(end stage renal disease,ESRD)患者死亡的主要原因是心血管疾病(cardiovascular disease,CVD),而血管钙化是发生心血管疾病的重要病因之一。最近研究表明血清可溶性Klotho(soluble Klotho,s KL)蛋白与慢性肾脏病(cronic kidney disease,CKD)患者矿物质代谢紊乱及血管钙化有关。本研究旨在了解腹膜透析(peritoneal dialysis,PD)患者腹主动脉钙化情况,并分析该人群血清s KL与腹主动脉钙化的关联性,为早期发现和评估PD患者的心血管病变提供理论依据。方法:选取持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)3个月以上的PD患者80例,收集其临床资料,应用侧位腹平片评价腹主动脉钙化情况,并计算腹主动脉钙化积分(abdominal aortic calcification score,AACs)。按血清s KL水平分布范围的四分位数分组,正常成人体检健康者55例为对照组。血清s KL及成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)浓度通过ELISA法检测。Logistic回归分析法分析PD患者发生腹主动脉中、重度钙化的危险因素,受试者工作特征曲线评价s KL预测腹主动脉中、重度钙化的准确性与特异性。结果:1 PD组与健康对照组比较:PD患者共80例,女性42例,男性38例,平均年龄(46.90±13.60)岁;健康对照组共55例,女性26例,男性29例,平均年龄(40.13±8.20)岁。性别、年龄二组间无统计学差异。PD组患者血清s KL较低,与健康对照组相比,差异有统计学意义[分别为(381.39±48.99)pg/ml比(478.85±58.13)pg/ml,P0.01]。2腹主动脉钙化情况:80例PD患者中,发生腹主动脉钙化患者41例(51.3%),轻度钙化(0AACs≤4)20例,中度钙化(5≤AACs≤15)15例,重度钙化(AACs≥16)6例。其中12例(29.3%)患者L1水平存在钙化,14例(34.2%)患者L2水平存在钙化,22例(53.7%)患者L3水平存在钙化,24例(58.5%)患者L4水平存在钙化。钙化主要发生在第四腰椎节段,并随着节段的上升逐渐减少。3按血清s KL水平分布范围的四分位数分组后四组的比较:I组:s KL≤351pg/m L;II组:s KL352~376pg/m L;III组:s KL377~415pg/m L;Ⅳ组:s KL≥416pg/m L。四组患者临床资料,生化指标,透析指标,并发症,用药史及FGF23均无统计学差异,P0.05。I组、II组患者的AAC积分高于Ⅳ组,不同s KL浓度组间AAC积分有统计学差异,P0.05。4血清s KL与AAC的关系:比较不同程度腹主动脉钙化组间的血清s KL水平发现,中度或重度钙化患者与轻度钙化患者相比,血清s KL更低,差异有统计学意义[(357.20±46.25)pg/ml、(319.33±48.64)pg/ml比(382.85±44.12)pg/ml,P0.05]。单因素直线相关分析显示s KL与AAC积分(r=-0.48,P0.01)、空腹血糖(r=-0.22,P0.05)、hs-CRP(r=-0.30,P0.01)负相关,与尿量正相关(r=0.23,P0.05),与其他因素无相关性。随着s KL水平的逐渐降低,高AAC评分患者的比例也显著增高,Ⅳ组腹主动脉中度及重度钙化患者的比例显著降低,而无钙化或轻度钙化患者的比例显著增加(P0.05)。5 PD患者发生腹主动脉中重度钙化危险因素分析:选择腹主动脉中、重度钙化(AACs≥5赋值为1)为应变量。Logistic回归分析结果显示,较低的血清s KL浓度(OR=0.966,95%CI0.945~0.988,P0.01)和较高年龄(OR=1.097,95%CI1.033~1.165,P0.01)是PD患者腹主动脉中、重度钙化的独立危险因素。与s KLP75的患者相比,s KLP25的患者发生腹主动脉中、重度钙化的危险度大。调整一般状况及相关临床生化指标后仍有统计学差异。6血清s KL预测腹主动脉中、重度钙化的准确性:血清s KL预测腹主动脉中、重度钙化的AUC为0.800(95%CI0.678~0.922,P0.01)。取s KL浓度361.50pg/m L作为截点时,其预测腹主动脉中、重度钙化的敏感性和特异性分别为71.4%和84.6%。结论:PD患者血清s KL浓度降低与发生腹主动脉钙化显著相关,其在腹主动脉钙化机制中起重要作用,血清s KL浓度测定可能有助于预测腹主动脉钙化。
[Abstract]:Objective: the main cause of death of patients with end-stage renal disease (end stage renal disease, ESRD) is cardiovascular disease (cardiovascular disease, CVD), and vascular calcification is one of the important causes of cardiovascular disease. Recent studies have shown that serum soluble Klotho (soluble Klotho, s) protein and chronic kidney disease (chronic renal disease) are the main causes of the disease. D) patients with mineral metabolism disorder and vascular calcification. The purpose of this study was to understand the calcification of abdominal aorta in patients with peritoneal dialysis (PD) and to analyze the association between serum s KL and abdominal aortic calcification in order to provide a theoretical basis for early detection and assessment of cardiovascular disease in PD patients. The clinical data were collected from 80 patients with continuous ambulatory peritoneal dialysis (CAPD) for more than 3 months. The clinical data were collected. Abdominal aortic calcification was used to evaluate the calcification of the abdominal aorta, and the abdominal aorta calcification score (abdominal aortic calcification score, AACs) was calculated. According to the four digits of the level of the level of the level of the serum s, it was positive. S KL and fibroblast growth factor 23 (fibroblast growth factor 23, FGF23) were detected by ELISA method to analyze the risk factors of severe calcification in the abdominal aorta by ELISA method, and the risk factors of severe calcification in the patients with PD were analyzed by ELISA method, and the predictive s KL was used to predict the abdominal aorta in the aorta and the severity of the abdominal aorta in the aorta, and the severity of the abdominal aorta in the abdominal aorta. Results: the accuracy and specificity of calcification. Results: 1 PD group and healthy control group: PD patients, 80 cases, 42 women, 38 men, average age (46.90 + 13.60) years, 55 cases of healthy control, 26 women, 29 men, average age (40.13 + 8.20) years. There is no statistical difference between groups in group.PD with low S KL. The difference was statistically significant [381.39 + 48.99) pg/ml ratio (478.85 + 58.13) pg/ml, P0.01].2 abdominal aorta calcification: 80 cases of PD patients, 41 cases of abdominal aortic calcification (51.3%), mild calcification (0AACs < 4) 20 cases, moderate calcification (5 < < AACs < 15) 15 cases, severe calcification (AACs > 16) 6 cases. There was calcification at the 1 level, calcification in L2 level in 14 cases (34.2%), calcification in L3 level in 22 cases (53.7%) and calcification in 24 cases (58.5%). Calcification mainly occurred in the fourth lumbar segment, and as the segment increased, the comparison of four groups after.3 was grouped by the four digits of serum s KL level: I group: s KL < 3. 51pg/m L; group II: s KL352~376pg/m L; III group: s KL377~415pg/m L; group IV: s KL > four groups of patients with clinical data, biochemical indicators, dialysis indexes, complications, medication history and no statistical difference. AAC relationship: a comparison of serum s KL levels between groups of abdominal aortic calcification found that the serum s KL was lower in patients with moderate or severe calcification compared with those with mild calcification, and the difference was statistically significant [(357.20 + 46.25) pg/ml, (319.33 + 48.64) pg/ml ratio (382.85 + 44.12) pg/ml, and P0.05]. single factor linear correlation analysis showed s KL and AAC integral (r=-0.48, P0.01), r=-0.22 (P0.05), hs-CRP (r=-0.30, P0.01) negative correlation, positive correlation with urine volume (r=0.23, P0.05), and no correlation with other factors. With the gradual decrease of s KL, the proportion of patients with high AAC score increased significantly, and the proportion of moderate and severe calcified abdominal aorta decreased significantly in group IV, without calcification or mild. The proportion of patients with calcification increased significantly (P0.05) in.5 PD patients with severe calcification in the abdominal aorta. In the selection of abdominal aorta, severe calcification (AACs > 5 is 1) was the result of.Logistic regression analysis, and the lower serum s KL concentration (OR= 0.966,95%CI0.945~0.988, P0.01) and higher age (OR=1.097,95%CI1.033~1.) 165, P0.01) is an independent risk factor for severe calcification in the abdominal aorta of PD patients. Compared with the s KLP75 patients, the risk of severe calcification in the abdominal aorta of the patients with s KLP25 is greater. The general condition and the related clinical biochemical parameters are still statistically different..6 serum s KL predicts the accuracy of severe calcification in the abdominal aorta, the accuracy of the severe calcification in the abdominal aorta: Serum s. KL predicted that severe calcification was 0.800 (95%CI0.678~0.922, P0.01) in the abdominal aorta. When s KL concentration 361.50pg/m L was taken as a cut point, the sensitivity and specificity of severe calcification in the abdominal aorta were 71.4% and 84.6%., respectively. The decrease of s KL concentration in the serum of PD patients was significantly related to the occurrence of abdominal aortic calcification, and it was calcium in the abdominal aorta. The serum s KL concentration may help predict the calcification of abdominal aorta.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.5

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