Laboratoire de Biochimie, CHRU Montpellier, F-34000 France; Univ Montpellier 1, Montpellier, F-34000 France.
Nephrol Dial Transplant. 2009 Nov;24(11):3389-97. doi: 10.1093/ndt/gfp301. Epub 2009 Jul 2.
Expression of bone proteins resulting from transdifferentiation of vascular smooth muscle cells into osteoblasts suggests that vascular calcifications are a bioactive process. Osteoprotegerin (OPG) could play a key role in bone-vascular calcification imbalance and could be a marker of vascular calcification extent and progression. The purpose of this study was to evaluate relationships between vascular risk biomarkers (including classic risk factors and OPG) and coronary artery calcification (CAC) extent in chronic kidney disease (CKD) patients and to establish within the markers the appropriate cut-off value to predict CAC.
A total of 133 non-dialyzed CKD patients at various stages of kidney disease [75 males/58 females, median age: 69.9 (27.4-94.6)] were enrolled, excluding extrarenal replacement therapy patients. All underwent chest multidetector computed tomography for CAC scoring. Blood samples were collected for measurement of vascular risk markers (kidney disease, inflammation, nutrition, calcium phosphate and OPG). A potential relationship between CAC and these biological markers was investigated, and a receiver-operating characteristic (ROC) curve was designed thereafter to identify a cut-off value of involved markers that best predicted the presence of CAC.
After adjustment for age, diabetes, smoking and gender, among biological markers, only low-estimated glomerular filtration rate using Modification of Diet in Renal Disease [OR = 3.63 (1.10-12.02)], high FEPO(4) [OR = 3.99 (1.17-13.6)] and high OPG levels [OR = 8.54 (2.14-34.11)] were associated with the presence of CAC. A protective effect of 1.25(OH)(2) vitamin D [OR = 0.20 (0.05-0.79)] and LDL cholesterol [OR = 0.27 (0.08-0.94)] on CAC was also observed. ROC curve analysis showed that the OPG best cut-off value predicting CAC was 757.7 pg/mL.
These results suggest that a CAC increase is strongly associated with a plasma OPG increase in CKD patients. The values of OPG >757.7 pg/mL allow us to predict the presence of CAC in these patients.
血管平滑肌细胞向成骨细胞的转分化导致骨蛋白的表达，这表明血管钙化是一个具有生物活性的过程。护骨素（OPG）可能在骨血管钙化失衡中发挥关键作用，并可作为血管钙化程度和进展的标志物。本研究旨在评估血管风险生物标志物（包括经典危险因素和 OPG）与慢性肾脏病（CKD）患者冠状动脉钙化（CAC）程度之间的关系，并确定标志物中预测 CAC 的适当临界值。
共纳入 133 名非透析 CKD 患者[75 名男性/58 名女性，中位年龄：69.9（27.4-94.6）]，排除肾外替代治疗患者。所有患者均接受胸部多层螺旋 CT 进行 CAC 评分。采集血样测量血管风险标志物（肾脏疾病、炎症、营养、钙磷和 OPG）。研究 CAC 与这些生物标志物之间的潜在关系，并设计其后的受试者工作特征（ROC）曲线，以确定预测 CAC 存在的最佳标志物临界值。
在校正年龄、糖尿病、吸烟和性别后，在生物标志物中，仅使用肾脏病饮食改良法估计的肾小球滤过率[比值比（OR）=3.63（1.10-12.02）]、高 FEPO（4）[OR=3.99（1.17-13.6）]和高 OPG 水平[OR=8.54（2.14-34.11）]与 CAC 的存在相关。1.25（OH）（2）维生素 D[OR=0.20（0.05-0.79）]和 LDL 胆固醇[OR=0.27（0.08-0.94）]对 CAC 也有保护作用。ROC 曲线分析显示，预测 CAC 的最佳 OPG 临界值为 757.7 pg/ml。
这些结果表明，在 CKD 患者中，CAC 的增加与血浆 OPG 的增加密切相关。OPG 值>757.7 pg/ml 可用于预测这些患者 CAC 的存在。
