Osteoprotegerin as a marker of cardiovascular risk in patients on peritoneal dialysis
Osteoprotegerin as a marker of cardiovascular risk in patients on peritoneal dialysis
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DOI：
10.20452/pamw.1678
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发表时间：
2013-01-01
影响因子：
--
通讯作者：
Sulowicz, Wladyslaw
中科院分区：
文献类型：
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作者：
Janda, Katarzyna;Krzanowski, Marcin;Sulowicz, Wladyslaw
简介 动脉增厚会导致接受维持性肾脏替代治疗的患者心血管风险升高。颈总动脉内膜中层厚度（CCA-IMT）是一种早期动脉粥样硬化标志物，可用于评估动脉粥样硬化进展和由此产生的动脉钙化的分层。 目的本研究的目的是评估以 CCA-IMT 表示的颈总动脉动脉粥样硬化变化与体重指数（BMI）、血脂之间的关系。 腹膜透析患者的水平、C 反应蛋白 (CRP) 和选定的骨代谢参数，包括磷、钙、完整甲状旁腺素 (iPTH)、碱性磷酸酶、骨桥蛋白、骨保护素、骨钙素、胎球蛋白 A 和成纤维细胞生长因子 23 (FGF-23)。 患者和方法 该研究包括 67 名年龄 53 +/- 13 岁（范围 19-75 岁）的慢性肾病患者（36 名男性和 31 名女性），接受腹膜透析治疗 30 +/- 24 个月。使用 Acuson 128/10 XP 通过超声检查评估 CCA-IMT。 BMI 使用 Quetelet 公式计算。使用标准实验室方法测量血清脂质水平、磷、钙、iPTH、碱性磷酸酶和CRP，而使用商业酶联免疫吸附测定试剂盒测量胎球蛋白A、骨钙素、骨保护素、骨桥蛋白和FGF-23。 结果观察到CCA-IMT与年龄之间呈正相关（r = 0.54，P < 0.0001），BMI（r = 0.39，P = 0.003）和骨保护素（r = 0.38，P = 0.004）。在多元回归分析中，年龄（r = 0.41，P = 0.01）、骨钙素（r = 0.34，P = 0.04）和对数转换的骨保护素值（r = 0.38，P = 0.02）仍然与 CCA-IMT 独立相关。在骨保护素浓度处于上三分位数的患者中观察到最高的 CCA-IMT 值 (0.85 +/- 0.21)。骨保护素浓度与透析治疗持续时间呈强烈正相关（r = 0.55，P < 0.0001）。 结论 CCA-IMT 已被证明是亚临床动脉粥样硬化的可靠无创测量方法，因此也是测量相关血管风险增加的可靠方法。血清骨保护素水平升高可能可作为透析患者心血管风险的预后标志物。
INTRODUCTION Arterial thickening contributes to elevated cardiovascular risk in patients on maintenance renal replacement therapy. The common carotid artery intima-media thickness (CCA-IMT) is an early atherosclerotic marker and may be used to assess the stratification of atherosclerotic advancement and resultant arterial calcification.OBJECTIVES The aim of the study was to evaluate the associations between atherosclerotic changes in the common carotid arteries expressed as the CCA-IMT and the body mass index (BMI), serum lipid levels, C-reactive protein (CRP), and selected bone metabolism parameters including phosphorus, calcium, intact parathormone (iPTH), alkaline phosphatase, osteopontin, osteoprotegerin, osteocalcin, fetuin A, and fibroblast growth factor-23 (FGF-23) in patients treated with peritoneal dialysis.PATIENTS AND METHODS The study included 67 patients with chronic kidney disease (36 men and 31 women) aged 53 +/- 13 years (range, 19-75 years) treated with peritoneal dialysis for 30 +/- 24 months. The CCA-IMT was assessed by ultrasonography using Acuson 128/10 XP. The BMI was calculated using the Quetelet formula. Serum lipid levels, phosphorus, calcium, iPTH, alkaline phosphatase, and CRP were measured using standard laboratory methods, while fetuin A, osteocalcin, osteoprotegerin, osteopontin, and FGF-23 using commercial enzyme-linked immunosorbent assay kits.RESULTS Positive correlations were observed between CCA-IMT and age (r = 0.54, P < 0.0001), BMI (r = 0.39, P = 0.003), and osteoprotegerin (r = 0.38, P = 0.004). In a multiple regression analysis, age (r = 0.41, P = 0.01), osteocalcin (r = 0.34, P = 0.04), and log-transformed osteoprotegerin values (r = 0.38, P = 0.02) remained independently associated with the CCA-IMT. The highest CCA-IMT values (0.85 +/- 0.21) were observed in patients with osteoprotegerin concentrations in the upper tertile. Osteoprotegerin concentrations strongly and positively correlated with the duration of dialysis treatment (r = 0.55, P < 0.0001).CONCLUSIONS The CCA-IMT has been shown to be a reliable noninvasive measure of subclinical atherosclerosis and, therefore, of associated increased vascular risk. Elevated serum osteoprotegerin levels may be useful as a prognostic marker of cardiovascular risk in dialyzed patients.