慢性肾脏病患者血清骨硬化蛋白浓度变化与心脏瓣膜钙化的关系研究

发布时间：2019-02-14 09:43

【摘要】：目的:研究慢性肾脏病(CKD)3-5期患者血清骨硬化蛋白(Sclerostin)浓度变化与心脏瓣膜钙化(Valve Calcification)的相关性,进一步探究慢性肾脏病患者骨硬化蛋白与心脏瓣膜钙化的关系,为临床中慢性肾脏病患者心血管疾病(CVD)的诊断和治疗提供一定的思路。方法:收集我院CKD3-5期患者90例,分为3组,其中CKD3期患者30例,CKD4期患者30例,CKD5期患者30例。另选取于我院健康查体中心行查体的健康志愿者20例(健康对照组)。由本院生化室采用Bayer ADVIA 1650自动生化仪检测患者血肌酐(Scr)、尿素氮(BUN)、碱性磷酸酶(AKP)、胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、钙(Ca)、磷(Pi)。由Beckman Array360 System测定C反应蛋白水平(CRP),计算患者的钙磷乘积(Ca×Pi),运用酶联免疫法(ELISA)测定患者血清骨硬化蛋白(Sclerostin)水平,运用MDRD简化公式计算各期患者肾小球率过滤(GFR)。由本院心脏彩超室专业医师运用飞利浦IE33超声心动仪测量心脏瓣膜钙化情况。统计分析CKD3-5期患者骨硬化蛋白浓度变化与心脏瓣膜钙化及各实验指标的关系。结果:(1)与健康对照组比较,CKD3、4、5期患者血清Ca降低(P0.05),PTH升高(P0.05),CKD4、5期血Pi、钙磷乘积升高(P0.05),差异有统计学意义;(2)从CKD3期开始患者血清骨硬化蛋白随着肾功能的减退逐步升高,血清骨硬化蛋白水平较健康对照组显著升高,且在终末期肾病时最高,差异有统计学意义(P0.01);(3)Pearson相关分析结果显示:血清骨硬化蛋白与肾小球滤过率(e GFR)(r=-0.91,P0.05)、血钙(r=-0.271,P0.05)呈负相关,与血肌酐(r=0.608,P0.05)、血磷水平(r=0.295,P0.05)、PTH(r=0.334,P0.05)、钙磷乘积(r=0.275,P0.005)呈正相关;(4)CKD5期患者心脏瓣膜钙化比例较高(11/30,36.67%),较健康对照组(1/20,5%)明显增加,差异有统计学意义(P0.01)。(5)心脏瓣膜钙化的Logitic回归分析示:骨硬化蛋白是CKD3-5期患者心脏瓣膜钙化的危险因素。结论:CKD3-5期患者血清骨硬化蛋白浓度随着肾功能下降而逐渐上升,血清骨硬化蛋白水平升高早于磷、钙磷乘积改变。CKD5期患者发生心脏瓣膜钙化风险明显升高。骨硬化蛋白是慢性肾脏病患者心脏瓣膜钙化的危险因素。
[Abstract]:Objective: to study the relationship between serum bone sclerosing protein (Sclerostin) concentration and cardiac valve calcification (Valve Calcification) in patients with chronic kidney disease (CKD) in stage 3-5, and to explore the relationship between bone sclerosing protein and cardiac valve calcification in patients with chronic kidney disease. To provide some ideas for the diagnosis and treatment of cardiovascular disease (CVD) in patients with chronic kidney disease. Methods: 90 patients with CKD3-5 in our hospital were divided into 3 groups: 30 patients with CKD3, 30 patients with CKD4 and 30 patients with CKD5. Another 20 healthy volunteers (healthy control group) were selected. Detection of serum creatinine, (Scr), urea nitrogen, (BUN), alkaline phosphatase, (AKP), cholesterol, (TC), triglyceride, (TG), high density lipoprotein (HDL), by Bayer ADVIA 1650 automatic biochemical instrument Low density lipoprotein (LDL), calcium (Ca), phosphorus (Pi). Serum osteosclerotic protein (Sclerostin) levels were measured by Beckman Array360 System, C-reactive protein level, (CRP), Ca 脳 Pi), and enzyme linked immunosorbent assay (ELISA). Application of simplified MDRD formula to calculate glomerular filtration (GFR). In patients with different stages Cardiac valve calcification was measured by Philips IE33 echocardiography. The relationship between the changes of bone sclerosing protein concentration and cardiac valve calcification in CKD3-5 patients was analyzed statistically. Results: (1) compared with the healthy control group, the serum Ca in patients with CKD3,4,5 was significantly lower than that in the control group (P0.05) (P0.05), and the calcium and phosphorus product of serum Pi, (P0.05) in the CKD4,5 phase was significantly higher than that in the control group (P0.05). (2) from the stage of CKD3, the serum osteosclerotic protein level of the patients increased gradually with the decrease of renal function, and the level of serum osteosclerotic protein was significantly higher than that of the healthy control group, and it was the highest at the end stage of renal disease (P0.01). (3) the results of Pearson correlation analysis showed that serum osteosclerotic protein was negatively correlated with glomerular filtration rate (e GFR) (), serum calcium (r = 0.271), and serum creatinine (r = 0.608, P 0.05). There was a positive correlation between serum phosphorus level (P 0.05, P 0.05) and calcium phosphorus product (P 0.005, P 0.05, P 0.05). (4) the rate of cardiac valve calcification in CKD5 patients was significantly higher than that in healthy controls (11 / 30 / 36.67% and 1 / 20 / 5%). The difference was statistically significant (P0.01). (5) the Logitic regression analysis showed that osteosclerotic protein was the risk factor of cardiac valve calcification in CKD3-5 patients. Conclusion: the concentration of serum osteosclerotic protein in patients with CKD3-5 increased gradually with the decrease of renal function. The level of serum osteosclerotic protein increased earlier than that of phosphorus, and the calcium and phosphorus product changed. The risk of cardiac valve calcification in patients with CKD5 increased significantly. Osteosclerotic protein is a risk factor for cardiac valve calcification in patients with chronic kidney disease.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692

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