胎球蛋白 A 作为血液透析患者死亡的风险因素。

Fetuin-A as a risk factor for mortality in hemodialysis patients.

机构信息

University Medical Center Maribor, Maribor, Slovenia.

出版信息

Wien Klin Wochenschr. 2010 May;122 Suppl 2:63-7. doi: 10.1007/s00508-010-1348-7.

DOI:10.1007/s00508-010-1348-7

PMID:20517675

Abstract

OBJECTIVES

Fetuin A, a circulating inhibitor of calcification, is regulated as a negative acute-phase protein. However, its relationship with outcomes of patients undergoing hemodialysis has not been well evaluated. The aim of our study was to determine the association between fetuin-A and some factors of metabolism and their impact on all-cause mortality in hemodialysis patients.

PATIENTS AND METHODS

The study comprised 106 hemodialysis patients, 45 of whom were women. Levels of serum fetuin-A were measured by ELISA and serum intact parathyroid hormone (iPTH) by immunoassay in each patient. Serum Ca, serum P, Ca x P product, alkaline phosphatase, cholesterol, triglycerides, bicarbonate, albumin, homocysteine and C-reactive protein (CRP) were measured using routine laboratory methods. Survival rates were analyzed using Kaplan-Meier survival curves. A Cox regression model was used to access the possible influence of variables on all-cause mortality.

RESULTS

The mean value of fetuin-A was 15.3 +/- 3.8 g/l, range 5.5-23.7 g/l. Significant correlations were found between serum fetuin-A and serum iPTH (r = -0.239; P = 0.014), alkaline phosphatase (r = -0.240; P = 0.013), triglycerides (r = +0.236; P = 0.015) and serum albumin level (r = +0.286; P = 0.003). Patients were followed-up prospectively from the first day of the laboratory measurement for a maximum of 752 days or until death. A total of 24 patients died. Surviving patients had higher levels of fetuin-A (P = 0.005), serum cholesterol (P = 0.0001), triglycerides (P = 0.004), albumin (P = 0.0001) and homocysteine (P = 0.028). Kaplan-Meier survival analysis showed higher mortality in the first tertile of fetuin-A than in the third tertile (P = 0.0297). In our patients, serum Ca (P = 0.025), serum P (P = 0.040) and the Ca x P product (P = 0.039) were found to be predictors of mortality in the Cox multivariable regression model.

CONCLUSIONS

In patients undergoing hemodialysis, lower fetuin-A levels are associated with higher mortality. Metabolism of Ca and P were directly associated with higher mortality.

摘要

目的

胎球蛋白 A 是一种循环钙化抑制剂，作为一种负急性相蛋白进行调节。然而，其与接受血液透析患者结局的关系尚未得到很好的评估。本研究的目的是确定胎球蛋白 A 与代谢的一些因素之间的关系，并评估其对血液透析患者全因死亡率的影响。

患者和方法

该研究纳入了 106 名血液透析患者，其中 45 名为女性。通过酶联免疫吸附法（ELISA）测定每位患者血清胎球蛋白 A 的水平，通过免疫测定法测定血清完整甲状旁腺激素（iPTH）的水平。使用常规实验室方法测定血清 Ca、血清 P、Ca x P 产物、碱性磷酸酶、胆固醇、甘油三酯、碳酸氢盐、白蛋白、同型半胱氨酸和 C 反应蛋白（CRP）。使用 Kaplan-Meier 生存曲线分析生存率。使用 Cox 回归模型评估变量对全因死亡率的可能影响。

结果

胎球蛋白 A 的平均值为 15.3±3.8g/L，范围为 5.5-23.7g/L。血清胎球蛋白 A 与血清 iPTH（r=-0.239；P=0.014）、碱性磷酸酶（r=-0.240；P=0.013）、甘油三酯（r=0.236；P=0.015）和血清白蛋白水平（r=0.286；P=0.003）呈显著相关。患者从实验室检测的第一天开始进行前瞻性随访，最长随访时间为 752 天或直至死亡。共有 24 名患者死亡。存活患者的胎球蛋白 A（P=0.005）、血清胆固醇（P=0.0001）、甘油三酯（P=0.004）、白蛋白（P=0.0001）和同型半胱氨酸（P=0.028）水平更高。Kaplan-Meier 生存分析显示，胎球蛋白 A 第 1 三分位组的死亡率高于第 3 三分位组（P=0.0297）。在我们的患者中，血清 Ca（P=0.025）、血清 P（P=0.040）和 Ca x P 产物（P=0.039）在 Cox 多变量回归模型中被发现是死亡率的预测因素。