Zhang Bin, Shi Wei, He Chao-sheng, Liang Xing-ling, Liu Shuang-xin, Liang Yong-zheng
Department of Nephrology, Guangdong General Hospital, Guangzhou 510080, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2010 May;30(5):1002-4.
To examine the relationship between reduction of serum fetuin A and coronary artery calcification (CAC) in patients starting hemodialysis.
Twenty-nine patients on chronic hemodialysis (duration of hemodialysis less than 6 months) were enrolled in this study. Serum fetuin A and such potential CAC-related risk factors as C-reactive protein (CRP), Ca, P, iPTH, body mass index (BMI) were examined. CAC was detected by multislice spiral CT scan (MSCT) and quantified by the modified Agaston's scoring system. All the 29 patients were followed up for 18 months to appraise the cardiovascular events defined as cardiac failure, angina pectoris or myocardial infarction.
Eleven patients (78.57%) were found to have CAC as detected by MSCT in low serum fetuin A (below the average serum concentration of 0.71 g/L) group, a rate significantly higher than that in high serum fetuin A group (7 patients, 46.67%, P<0.05). Serum fetuin A in these 29 patients was related with CAC score (Pearson correlation coefficient of -0.734, P=0.001) and stepwise regression analysis indicated that serum fetuin A (standardized beta=-0.568, P=0.003) and age (standardized beta=0.416, P=0.019) were independently correlated to CAC. Such factors as CRP, Ca, P, iPTH, Chol, TG, HDL-C, LDL-C, BMI and blood pressure were excluded from the regression equation. Reduction of serum fetuin A was associated with cardiovascular events (Spearman's rho -0.758, P<0.01). No significant difference was found between low and high serum fetuin A groups by Kaplan-Meier survival analysis (P=0.065).
Reduced serum fetuin A may be a potential risk factor of coronary artery calcification, and can contribute to cardiovascular events in patients starting hemodialysis.
探讨开始血液透析的患者血清胎球蛋白A降低与冠状动脉钙化（CAC）之间的关系。
本研究纳入了29例慢性血液透析患者（血液透析时间少于6个月）。检测血清胎球蛋白A以及C反应蛋白（CRP）、钙（Ca）、磷（P）、全段甲状旁腺激素（iPTH）、体重指数（BMI）等潜在的与CAC相关的危险因素。通过多层螺旋CT扫描（MSCT）检测CAC，并采用改良的阿加斯顿评分系统进行量化。对这29例患者进行18个月的随访，以评估定义为心力衰竭、心绞痛或心肌梗死的心血管事件。
在血清胎球蛋白A水平低（低于平均血清浓度0.71g/L）的组中，11例患者（78.57%）经MSCT检测发现有CAC，该比例显著高于血清胎球蛋白A水平高的组（7例患者，46.67%，P<0.05）。这29例患者的血清胎球蛋白A与CAC评分相关（Pearson相关系数为-0.734，P=0.001），逐步回归分析表明血清胎球蛋白A（标准化β=-0.568，P=0.003）和年龄（标准化β=0.416，P=0.019）与CAC独立相关。CRP、Ca、P、iPTH、胆固醇（Chol）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、BMI和血压等因素被排除在回归方程之外。血清胎球蛋白A降低与心血管事件相关（Spearman等级相关系数-0.758，P<0.01）。Kaplan-Meier生存分析显示，血清胎球蛋白A水平低和高的组之间无显著差异（P=0.065）。
血清胎球蛋白A降低可能是冠状动脉钙化的潜在危险因素，并可促使开始血液透析的患者发生心血管事件。
