摘要
目的探讨维持性血液透析（MHD）患者血清可溶性Klotho（sKL）水平与预后的关系。方法收集129例MHD患者临床资料，采用ELISA法检测血清sKL浓度。应用腹部侧位平片评判患者腹主动脉钙化情况，计算腹主动脉钙化积分（AAC）。用Cox回归分析MHD患者心血管疾病（CVD）死亡的危险因素，Kaplan—Meier生存曲线分析MHD患者sKL与死亡之间的关系。结果129例MHD患者中全因死亡27例（占20．9％），CVD死亡19例（14．7％）。中位sKL浓度为612．6（379．2，816．6）ng／L，Log[iPTH]是影响sKl浓度的独立影响因素。与高sKL组相比，低sKL组患者具有更高AAC积分以及更高的CVD病死率（均P〈0．05）。Kaplan—Meier生存曲线显示低sKL组与高sKL组患者全因死亡率差异无统计学意义（P=0．541），低sKL组CVD病死率显著高于高sKL组（P=0．036）。Cox回归分析显示SKl水平降低与MHD患者CVD病死率升高相关[OR=0．352，95％CI（0．127～0．977），P=0．0451，即使校正一般情况、生化指标后这种关系依然存在[OR=0．331，95％CI（0．117～0．933），P=0．037]。在无或轻度腹主动脉钙化患者中（AAC≤4），低sKl组与高sKL组患者全因死亡率差异无统计学意义（P=0．522），而低sKl组患者CVD病死率显著高于高sKL组（P=0．035）；在中重度钙化组（AAC≥5）患者中，低sKL组与高sKL组患者全因死亡和CVD死亡差异均无统计学意义（P分别为0．991和0．522）。结论低水平sKL的MHD患者具有较高CVD病死率，sKL浓度降低是MHD患者CVD死亡的独立危险因素。在无或钙化较轻的患者中低浓度的sKL可以预测MHD患者CVD死亡。本研究提示sKL水平可能有助于预测MHD患者的预后。
Objective To determine the relationship between serum soluble Klotho （sKL） level and adverse outcome in maintenance hemodialysis （MHD） patients. Methods One hundred and twenty nine cases of MHD patients were collected prospectively. Serum sKL was detected by ELISA. Abdomen lateral plain was used as a criterion to determine the abdominal aortic calcification. The abdominal aortic calcification score （AAC） was calculated. Cox regression analysis was used to determine the risk factor of cardiovascular death （CVD） in MHD patients. Kaplan-Meier showed the relationship between sKL and CVD in MHD patients. Results There were 27 cases （20.9%） of all- cause death and 19 cases （14.7%） of cardiovascular death. The median sKL was 612.6（379.2-816.6） ng/L, and log[iPTH] was an independent factor of sKL concentration. Low sKL had high AAC and CVD death rate. Kaplan-Meier method showed that the all-cause death rate was similar between two groups, and CVD death rate increased significantly in low sKL patients （P=0.036）. Cox regression indicated that lower sKL level was associated with high CVD death rate [0R=0.352, 95%CI（0.127- 0.977）, P= 0.045].After adjustment for the general condition, biochemical indicators, the relationship still existed [OR=0.331, 95% CI （0.117-0.933）, P=0.037]. In no or mild vascular calcification patients （AAC ≤4）, compared with high sKL patients, low sKL patients had no significant difference rate in all- cause mortality. The CVD mortality was significantly higher in high sKL （P=0.035） compared with low sKL. In severe calcification group （AAC 〉 4）, all- cause death and CVD death rates were similar between different sKL groups （P=0.991 and 0.522, respectively）. Conclusions Lower sKL has the high CVD death rate and sKL level decreasing is an independent risk factor for CVD death in MHD patients. The lower sKL concentration in MHD patients with no or mild calcification may predict CVD mortality. This study suggests that sKL levels may be helpful in predicting the outcome of patients with MHD.
出处
《中华肾脏病杂志》
CSCD
北大核心
2017年第5期334-341,共8页
Chinese Journal of Nephrology
基金
上海市卫生和计划生育委员会科研课题（201640100）
上海交通大学医学院附属仁济医院南院临床学科创新共建平台建设项目（2014MDT02）
关键词
肾透析
心血管疾病
预后
可溶性Klotho
腹主动脉钙化
Renal dialysis
Cardiovascular diseases
Prognosis
Soluble Klotho
Abdominal aorta calcification
