腹膜透析患者血清肌腱蛋白-C与腹主动脉钙化的相关研究

doi:10.12114/j.issn.1007-9572.2019.00.586

摘要/Abstract

摘要： 背景　动脉粥样硬化性心血管疾病（CVD）是终末期肾脏病（ESRD）患者致残和致死的主要原因，近年来大量研究发现血管钙化是引起ESRD患者发生CVD的一个关键危险因素，目前已有动物及细胞水平的研究发现血清肌腱蛋白-C（TN-C）参与血管钙化机制，但临床研究相对少见。目的　研究腹膜透析（PD）患者血清TN-C水平及腹主动脉钙化的情况及其相关因素，并分析该人群二者之间的相关性。方法　选择2017年9月—2018年10月在青岛市市立医院肾内科持续不卧床腹膜透析（CAPD）≥3个月的80例患者。收集其临床资料，采用酶联免疫吸附试验（ELISA）检测其血清TN-C水平，腹部侧位X线平片评估腹主动脉钙化程度，计算腹主动脉钙化积分（ACCs）。以血清TN-C中位数为界，分为低TN-C组和高TN-C组。依据患者AACs分为无和轻度钙化组（0≤AACs≤4分）、中重度钙化组（>4分）。采用多因素Logistic回归分析研究PD患者TN-C、腹主动脉钙化的危险因素，采用受试者工作特征（ROC）曲线评价TN-C预测PD患者发生腹主动脉钙化的临床价值。结果　本研究80例PD患者中位TN-C水平为63.27（60.78，66.56） μg/L，低TN-C组40例，高TN-C组40例。发生腹主动脉钙化患者66例（82.5%），无和轻度钙化组38例，中重度钙化组42例。高TN-C组患者透析龄大于低TN-C组（P<0.01）。中重度钙化组患者的年龄和透析龄大于无和轻度钙化组，原发病为糖尿病肾病比例高于无和轻度钙化组（P<0.05）。高TN-C组患者甲状旁腺激素、血钙、TN-C、AACs高于低TN-C组（P<0.05）。中重度钙化组患者的甲状旁腺激素、血磷、碱性磷酸酶、TN-C、AACs高于无和轻度钙化组（P<0.05）。TN-C与患者的年龄、透析龄、甲状旁腺激素、血钙、AACs水平呈正相关（rs=0.29、0.41、0.54、0.35、0.73，P<0.01），与清蛋白水平呈负相关（rs=-0.23，P<0.05）。多因素Logistic回归分析结果显示，血清甲状旁腺激素较高〔OR=1.003，95%CI（1.000，1.005），P<0.05〕和高AACs〔OR=1.148，95%CI（1.029，1.282），P<0.05〕是PD患者高血清TN-C的独立危险因素。腹主动脉钙化与患者的年龄、透析龄、甲状旁腺激素、血磷、血钙、碱性磷酸酶、TNC水平呈正相关（rs=0.34、0.39、0.49、0.22、0.25、0.38、0.73，P<0.05），与清蛋白水平呈负相关（rs=-0.23，P<0.05）。多因素Logistic回归模型结果显示，血清TN-C水平较高〔OR=1.605，95%CI（1.156，2.228），P<0.01〕、高龄〔OR=1.072，95%CI（1.006，1.143），P<0.05〕和高磷〔OR=10.407，95%CI（1.480，73.197），P<0.05〕是PD患者发生腹主动脉中重度钙化的独立危险因素。TN-C预测PD患者发生腹主动脉中重度钙化的ROC曲线下面积为0.856，诊断截点为63.87 μg/L，灵敏度为71.4%，特异度为94.7%。结论　PD患者血清TN-C水平升高与腹主动脉钙化程度呈正相关，血清TN-C在PD患者腹主动脉钙化发生机制中可能参与钙化起始及进展过程。

关键词: 腹膜透析, 持续不卧床, 肌腱蛋白-C, 血管钙化

Abstract: Background　Atherosclerotic cardiovascular disease（CVD） is the leading cause of disability and death in patients with end-stage renal disease（ESRD）．In recent years，a large number of studies have found that vascular calcification is a key risk factor for CVD in patients with ESRD.Studies on animals and at cell level have found that tenascin-C（TN-C） is involved in the mechanism of vascular calcification，but clinical studies are relatively rare.Objective　 To investigate the serum tenosin-C（TN-C） level，abdominal aortic calcification and related factors in patients with peritoneal dialysis （PD），and to analyze their correlation in this population.Methods　Eighty patients with continuous ambulatory peritoneal dialysis（CAPD） for more than 3 months in Qingdao Municipal Hospital were selected from September 2017 to October 2018．Their clinical data were collected.The levels of serum TN-C were detected by enzyme-linked immunosorbent assay （ELISA）．Abdomen lateral plain was used as a criterion to determine the abdominal aortic calcification．The abdominal aortic calcification score（AACs） was calculated．According to the median TN-C level，the patients were divided into low TN-C group and high TN-C group.According to AACs，the patients were divided into the non- and mild calcification group （0≤AACs≤4 points） and the moderate-to-severe calcification group（>4 points）．Logistic regression analysis was used to determine the risk factor of abdominal aortic calcification and TN-C in PD patients．The receiver operating characteristics（ROC） analysis was applied to evaluate the predict value of TN-C in abdominal aortic calcification.Results　In this study，the median serum TN-C level was 63.27（60.78，66.56）μg/L，and 40 patients were in the low TN-C group，40 patients in the high TN-C group.There were 66 patients（82.5%） with abdominal aortic calcification，38 patients were in the non- and mild calcification group and 42 patients in the moderate-to-severe calcification group.The dialysis age of patients in the high TN-C group was greater than that in the low TN-C group （P<0.01）．The age and dialysis age of patients in the moderate-to-severe calcification group were older than those in the non- and mild calcification group.The proportion of primary diabetic nephropathy in the moderate-to-severe calcification group was higher than that in the non- and mild calcification group（P<0.05）．Parathyroid hormone（PTH），serum Ca，TN-C and AACs were higher in the high TN-C group than those in the low TN-C group （P<0.05）．PTH，serum phosphorus，alkaline phosphatase（ALP），TN-C，and AACs were higher in the moderate-to-severe calcification group than those in the non-and mild calcification group （P<0.05）．TN-C was positively correlated with age，dialysis age，PTH，serum Ca，and AACs levels（rs=0.29、0.41、0.54、0.35、0.73，P<0.01），and negatively correlated with albumin （Alb） levels （rs=-0.23，P<0.05）．Logistic regression analysis showed that high serum PTH level〔OR=1.003，95%CI（1.000，1.005），P<0.05〕and high AACs〔OR=1.148，95%CI（1.029，1.282），P<0.05〕 were independent risk factors for high serum TN-C.Abdominal aortic calcification was positively correlated with age，dialysis age，PTH，ALP，serum phosphorus，serum Ca，and TNC levels（rs=0.34、0.39、0.49、0.22、0.25、0.38、0.73，P<0.05），and negatively correlated with Alb level（rs=-0.23，P<0.05）．Logistic regression analysis showed that high serum TN-C level〔OR=1.605，95%CI（1.156，2.228），P<0.01〕，senior age〔OR=1.072，95%CI（1.006，1.143），P<0.05〕and high serum phosphate level〔OR=10.407，95%CI（1.480，73.197），P<0.05〕were independent risk factors for moderate-to-severe calcification of the abdominal aorta．ROC-AUC of serum TN-C for moderate to severe abdominal aortic calcification was 0.856，cut-off value 63.87 μg/L，sensitivity 71.4%，and specificity 94.7%.Conclusion　The high serum TN-C is positively associated with abdominal aortic calcification．Serum TN-C may play an important role in the initiation and progression mechanism of abdominal aortic calcification in PD patients.

Key words: Peritoneal dialysis, continuous ambulatory；Tenascin-C；Vascular calcification

刘媛,隋小妮,王安阳,等. 腹膜透析患者血清肌腱蛋白-C与腹主动脉钙化的相关研究[J]. 中国全科医学, 2020, 23(3): 312-318. DOI: 10.12114/j.issn.1007-9572.2019.00.586.
LIU Yuan,SUI Xiaoni,WANG Anyang, et al. Serum Tenascin-C and Abdominal Aortic Calcification in Peritoneal Dialysis Patients　[J]. Chinese General Practice, 2020, 23(3): 312-318. DOI: 10.12114/j.issn.1007-9572.2019.00.586.

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