Association Among Serum Fetuin-A Level, Coronary Artery Calcification, and Bone Mineral Densitometry in Maintenance Hemodialysis Patients
Association Among Serum Fetuin-A Level, Coronary Artery Calcification, and Bone Mineral Densitometry in Maintenance Hemodialysis Patients
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DOI：
10.1111/j.1525-1594.2009.00814.x
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发表时间：
2009-10-01
影响因子：
2.4
通讯作者：
Turgan, Cetin
中科院分区：
文献类型：
--
作者：
Kirkpantur, Alper;Altun, Bulent;Turgan, Cetin
终末期肾病患者动脉钙化的发生率和程度都很高。许多研究表明，动脉粥样硬化斑块钙化和骨形成的发生和发展与相似的病理生理机制有关。胎球蛋白-A是一种有效的钙化抑制因子，在骨骼中表达，功能尚不明确。本研究的目的是研究骨矿密度参数、冠状动脉钙化和血清胎球蛋白-A水平之间的关系。在横断面设计中，我们包括72名维持性血液透析(HD)患者和30名年龄和性别匹配的健康对照组。研究维持性血液透析患者和健康对照组的血清胎球蛋白-A水平。维持性血液透析患者采用双能X线骨密度仪测定桡骨、髋部和腰椎骨密度(BMD)，电子束CT测定冠状动脉钙化积分(CACs)。研究维持性血液透析患者特定部位骨密度参数、CACs和血清胎球蛋白-A水平之间的关系。T积分低于-2.5分的患者，其冠状动脉斑块的CACs、质量和体积显著高于股骨近端、股骨颈、股骨粗隆和腰椎。维持性血液透析患者血清胎球蛋白A平均浓度为0.636±0.118 g/L，低于健康对照组(0.829±0.100 g/L，P<0.0001)。冠状动脉内CACs、斑块质量和体积与血清胎球蛋白-A水平显著相关。此外，血清胎球蛋白-A水平、骨密度值与股骨近端、股骨颈和股骨粗隆的T评分呈显著正相关，但与腰椎无关。目前的研究表明，在维持性HD患者中，除了腰椎外，血清胎球蛋白-A水平、冠状动脉钙化和骨密度之间存在关联。然而，由于这项研究的横断面设计，对结果的解释应该谨慎。
Patients with end-stage renal disease have a very high prevalance and extent of arterial calcification. A number of studies suggest that similar pathophysiologic mechanisms are responsible for development and progression of calcification of atherosclerotic plaque and bone formation. Fetuin-A is a potent calcification inhibitor and is expressed in bone, with not-yet well-defined functions. The aim of this study was to investigate the relation between bone mineral densitometry parameters, coronary artery calcification, and serum fetuin-A levels. In a cross-sectional design, we included 72 maintenance hemodialysis (HD) patients and 30 age- and gender- matched healthy controls. Serum fetuin-A levels were studied both in maintenance HD patients and healthy controls. Maintenance HD patients had radius, hip, and lumbar spine bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry and coronary artery calcification score (CACS) measured by electron-beam computed tomography. The associations between site-specific BMD parameters, CACS, and serum fetuin-A levels were studied in maintenance HD patients. CACS, mass, and volume of plaques in coronary arteries were significantly higher in patients with a T-score below -2.5 than above in the proximal region of the radius, neck and trochanter of the femur, and the lumbar spine. Mean serum fetuin-A concentration was 0.636 +/- 0.118 g/L in maintenance HD patients and it was less than healthy controls (0.829 +/- 0.100 g/L, P < 0.0001). CACS, mass, and volume of plaques in coronary arteries correlated significantly with the serum fetuin-A levels. Moreover, significant positive correlations were shown between the serum fetuin-A levels, BMD values, and T-scores of proximal radius, neck, and trochanter of the femur, but not with the lumbar spine. The present study demonstrates an association between serum fetuin-A levels, coronary artery calcification, and bone mineral densities-except for the lumbar spine, in maintenance HD patients. However, the results should be interpreted with caution because of the cross-sectional design of the study.