血清dp-ucMGP水平与维持性血液透析患者血管钙化的相关性研究

doi:10.3877/cma.j.issn.2095-3216.2021.06.003

目的

探讨血清去磷酸化未羧化基质谷氨酸蛋白(dp-ucMGP)与维持性血液透析(MHD)患者冠状动脉钙化的关系。

方法

选取MHD患者89例和健康体检对照者40例，行胸部CT检查，计算冠状动脉钙化积分；检测血清维生素K2、dp-ucMGP、未羧化基质谷氨酸蛋白(ucMGP)、钙、磷、全段甲状旁腺素等指标；使用Spearman相关分析方法评价冠脉钙化积分与dp-ucMGP等指标的相关性。

结果

MHD患者组血清dp-ucMGP水平高于对照组(13.5±2.65 vs 7.16±2.09 ng/ml，P<0.01)。在MHD组中患者冠状动脉钙化积分与血清dp-ucMGP水平呈正相关(r＝0.59，P<0.01)，而与ucMGP水平无明显相关性(r＝-0.11，P＝0.30)。在MHD患者组使用dp-ucMGP诊断冠脉钙化时，绘制受试者工作特征曲线(ROC)，曲线下面积为0.769(95%CI: 0.661~0.877，P<0.001)，dp-ucMGP对冠脉钙化的诊断有意义。

结论

MHD患者血清dp-ucMGP高于正常人，与冠脉钙化呈正相关性。检测血清dp-ucMGP，有助于评价血液透析患者冠脉钙化情况。

关键词: 去磷酸化-未羧化基质谷氨酸蛋白, 维生素K2, 血液透析, 血管钙化

Objective

To investigate the correlation between serum dephosphorylated-uncarboxylated matrix glutamate protein (dp-ucMGP) and coronary artery calcification in maintenance hemodialysis (MHD) patients.

Methods

A total of 89 MHD patients and 40 healthy persons as the control were selected. Chest CT examination and coronary artery calcification score calculation were performed. The serum vitamin K2, dp-ucMGP, uncarboxylated matrix glutamate protein (ucMGP), calcium, phosphorus, intact parathyroid hormone, and other indicators were measured. The correlation between coronary calcification score and dp-ucMGP and others was analyzed with the Spearman correlation analysis method.

Results

The serum dp-ucMGP level of MHD patients group was higher than that of the control group (13.5±2.65 vs 7.16±2.09 ng/ml, P<0.01). The coronary artery calcification score in MHD group was positively correlated with the serum dp-ucMGP level (r=0.59, P<0.01), but not with the ucMGP level (r=-0.11, P=0.30). In the MHD patient group, when dp-ucMGP was used to diagnose coronary calcification, and the receiver operating characteristic curve (ROC) was drawn. The area under the curve was 0.769 (95%CI: 0.661-0.877, P<0.001), indicating that dp-ucMGP was of significane for the diagnosis of coronary artery calcification.

Conclusion

The serum dp-ucMGP level of MHD patients was higher than that of the normal control, and had a positive correlation with the coronary calcification score. Detection of the serum dp-ucMGP rather than the ucMGP may be helpful for evaluating the coronary calcification in MHD patients.

Key words: Dp-ucMGP, Vitamin K2, Hemodialysis, Vascular calcification

表1 各组一般资料及临床生化指标比较

项目	对照组(n＝40)	病例组(n＝89)	t/Z/χ²值	P值
年龄(岁)	59.80±13.14	62.29±14.36	-0.94	0.35
男/女(例)	22/18	45/44	0.22	0.64
血红蛋白(g/L)	141.73±13.33	96.27±21.21	14.75	<0.01
钙(mmol/L)	2.31±0.15	2.19±0.27	3.19	<0.01
磷(mmol/L)	1.22±0.19	1.63±0.50	-6.69	<0.01
C反应蛋白(mg/L)	0.40(0.13，0.68)	4.55(0.23，33.27)	-4.31	<0.01
白蛋白(g/L)	44.56±6.44	38.46±5.54	5.19	<0.01
甘油三酯(mmol/L)	1.15(0.88，1.66)	1.49(0.93，2.13)	-1.47	0.14
全段甲状旁腺激素(ng/L)	37(23，54)	364(205，619)	-9.06	<0.01
维生素K₂(nmol/L)	7.67(6.65，8.24)	3.09(1.97，5.15)	-8.76	<0.01
ucMGP(ng/ml)	11.13(9.51，11.78)	5.74(4.08，7.16)	-8.92	<0.01
dp-ucMGP(ng/ml)	7.16±2.09	13.47±2.65	-13.30	<0.01
钙化积分	0.0(0.0，0.0)	263.1(33.1，845.7)	-8.02	<0.01

表1 各组一般资料及临床生化指标比较

项目	对照组(n＝40)	病例组(n＝89)	t/Z/χ²值	P值
年龄(岁)	59.80±13.14	62.29±14.36	-0.94	0.35
男/女(例)	22/18	45/44	0.22	0.64
血红蛋白(g/L)	141.73±13.33	96.27±21.21	14.75	<0.01
钙(mmol/L)	2.31±0.15	2.19±0.27	3.19	<0.01
磷(mmol/L)	1.22±0.19	1.63±0.50	-6.69	<0.01
C反应蛋白(mg/L)	0.40(0.13，0.68)	4.55(0.23，33.27)	-4.31	<0.01
白蛋白(g/L)	44.56±6.44	38.46±5.54	5.19	<0.01
甘油三酯(mmol/L)	1.15(0.88，1.66)	1.49(0.93，2.13)	-1.47	0.14
全段甲状旁腺激素(ng/L)	37(23，54)	364(205，619)	-9.06	<0.01
维生素K₂(nmol/L)	7.67(6.65，8.24)	3.09(1.97，5.15)	-8.76	<0.01
ucMGP(ng/ml)	11.13(9.51，11.78)	5.74(4.08，7.16)	-8.92	<0.01
dp-ucMGP(ng/ml)	7.16±2.09	13.47±2.65	-13.30	<0.01
钙化积分	0.0(0.0，0.0)	263.1(33.1，845.7)	-8.02	<0.01

表2 MHD组钙化积分分组后组间指标比较

项目	无钙化组(n＝27)	低分钙化组(n＝28)	高分钙化组(n＝34)	F/H/χ²值	P值
年龄(岁)	61.6±14.7	61.8±13.5	63.3±15.1	0.13	0.88
男/女(例)	13/14	14/14	18/16	0.14	0.93
血红蛋白(g/L)	102.9±26.9	93.9±15.7	92.9±19.4	1.97	0.25
C反应蛋白(mg/L)	2.36(0.51，21.4)	2.84(0.11，25.7)	10.2(0.46，41.7)	1.60	0.45
钙(mmol/L)	2.22±0.23	2.18±0.36	2.18±0.23	0.25	0.78
磷(mmol/L)	1.35(1.12，1.65)	1.61(1.37，1.93)	1.65 (1.41，2.20)^a	9.33	<0.01
白蛋白(g/L)	39.1±5.50	38.7±5.90	37.8±5.36	0.49	0.61
甘油三酯(mmol/L)	1.40(0.88，1.93)	1.56(0.98，2.27)	1.60(0.96，2.06)	0.51	0.78
全段甲状旁腺激素(ng/L)	197(110，356)	338(140，463)	642(453，961) ^ab	47.4	<0.01
维生素K₂(nmol/L)	4.98(3.21，5.87)	3.71(2.05，4.91)	2.13(1.43，2.80)^a	20.9	<0.01
ucMGP(ng/ml)	5.71(4.28，6.98)	5.96(3.46，7.56)	5.62(3.78，7.02)	0.46	0.79
dp-ucMGP(ng/ml)	11.8±2.24	12.9±1.97	15.3±2.38ab	19.9	<0.01

表2 MHD组钙化积分分组后组间指标比较

项目	无钙化组(n＝27)	低分钙化组(n＝28)	高分钙化组(n＝34)	F/H/χ²值	P值
年龄(岁)	61.6±14.7	61.8±13.5	63.3±15.1	0.13	0.88
男/女(例)	13/14	14/14	18/16	0.14	0.93
血红蛋白(g/L)	102.9±26.9	93.9±15.7	92.9±19.4	1.97	0.25
C反应蛋白(mg/L)	2.36(0.51，21.4)	2.84(0.11，25.7)	10.2(0.46，41.7)	1.60	0.45
钙(mmol/L)	2.22±0.23	2.18±0.36	2.18±0.23	0.25	0.78
磷(mmol/L)	1.35(1.12，1.65)	1.61(1.37，1.93)	1.65 (1.41，2.20)^a	9.33	<0.01
白蛋白(g/L)	39.1±5.50	38.7±5.90	37.8±5.36	0.49	0.61
甘油三酯(mmol/L)	1.40(0.88，1.93)	1.56(0.98，2.27)	1.60(0.96，2.06)	0.51	0.78
全段甲状旁腺激素(ng/L)	197(110，356)	338(140，463)	642(453，961) ^ab	47.4	<0.01
维生素K₂(nmol/L)	4.98(3.21，5.87)	3.71(2.05，4.91)	2.13(1.43，2.80)^a	20.9	<0.01
ucMGP(ng/ml)	5.71(4.28，6.98)	5.96(3.46，7.56)	5.62(3.78，7.02)	0.46	0.79
dp-ucMGP(ng/ml)	11.8±2.24	12.9±1.97	15.3±2.38ab	19.9	<0.01

图1 血管钙化积分与血清dp-ucMGP关系(呈正相关)注：dp-ucMGP：去磷酸化-未羧化基质谷氨酸蛋白

图2 血清dp-ucMGP与ucMGP关系(无相关性)注：dp-ucMGP：去磷酸化-未羧化基质谷氨酸蛋白；ucMGP：未羧化基质谷氨酸蛋白

图3 血清dp-ucMGP、血磷、全段甲状旁腺激素诊断钙化的ROC曲线注：dp-ucMGP：去磷酸化-未羧化基质谷氨酸蛋白；P：磷；iPTH：intact PTH，全段甲状旁腺激素

图4 联合因子诊断钙化的ROC曲线

表3 钙化积分与临床相关指标的多元回归分析

项目	回归系数	标准误	标准化回归系数	t值	P值
常量	-11.153	4.721		-2.362	0.020
全段甲状旁腺激素(X1)	0.021	0.003	0.467	6.676	<0.001
dp-ucMGP(X2)	1.614	0.316	0.321	5.102	<0.001
维生素K2(X3)	-2.149	0.447	-0.281	-4.810	<0.001
血磷(X4)	3.455	1.583	0.131	2.183	0.032

表3 钙化积分与临床相关指标的多元回归分析

项目	回归系数	标准误	标准化回归系数	t值	P值
常量	-11.153	4.721		-2.362	0.020
全段甲状旁腺激素(X1)	0.021	0.003	0.467	6.676	<0.001
dp-ucMGP(X2)	1.614	0.316	0.321	5.102	<0.001
维生素K2(X3)	-2.149	0.447	-0.281	-4.810	<0.001
血磷(X4)	3.455	1.583	0.131	2.183	0.032

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Study on the correlation between serum dp-ucMGP level and vascular calcification in maintenance hemodialysis patients

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Study on the correlation between serum dp-ucMGP level and vascular calcification in maintenance hemodialysis patients