From the Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China (A.Y.-M.W., S.W.); Department of Chemical Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China (C.-K.W.); Biomedical Imaging Center, Central, Hong Kong, China (Y.-Y.Y.); Department of Pathology, United Christian Hospital, Hong Kong, China (I.H.-S.C.); and Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China (C.W.-K.L.).
Arterioscler Thromb Vasc Biol. 2014 Aug;34(8):1784-90. doi: 10.1161/ATVBAHA.114.303378. Epub 2014 May 29.
This study aims to evaluate the relationship between tissue advanced glycation end products, as reflected by skin autofluorescence, and vascular calcification in chronic kidney disease.
Three hundred patients with stage 3 to 5 chronic kidney disease underwent multislice computed tomography to estimate total coronary artery calcium score (CACS) and had tissue advanced glycation end product assessed using a skin autofluorescence reader. Intact parathyroid hormone (P<0.001) displaced estimated glomerular filtration rate as third most significant factor associated with skin autofluorescence after age (P<0.001) and diabetes mellitus (P<0.001) in multiple regression analysis. On univariate multinomial logistic regression analysis, every 1-U increase in skin autofluorescence was associated with a 7.43-fold (95% confidence intervals, 3.59-15.37; P<0.001) increased odds of having CACS ≥400 compared with those with zero CACS. Skin autofluorescence retained significance in predicting CACS ≥400 (odds ratio, 3.63; 95% confidence intervals, 1.44-9.18; P=0.006) when adjusting for age, sex, serum calcium, phosphate, albumin, C-reactive protein, lipids, blood pressure, estimated glomerular filtration rate, and intact parathyroid hormone but marginally lost significance when additionally adjusting for diabetes mellitus (odds ratio, 2.23; 95% confidence intervals, 0.81-6.14; P=0.1). Combination of diabetes mellitus and higher intact parathyroid hormone was associated with greater skin autofluorescence and CACS versus those without diabetes mellitus and having lower intact parathyroid hormone.
Tissue advanced glycation end product, as reflected by skin autofluorescence, showed a significant novel association with vascular calcification in chronic kidney disease. These data suggest that increased tissue advanced glycation end product may contribute to vascular calcification in chronic kidney disease and diabetes mellitus and warrant further experimental investigation.
本研究旨在评估皮肤自发荧光所反映的组织晚期糖基化终产物与慢性肾脏病患者血管钙化之间的关系。
300 名 3 至 5 期慢性肾脏病患者接受多层计算机断层扫描以评估总冠状动脉钙评分（CACS），并使用皮肤自发荧光读数仪评估组织晚期糖基化终产物。在多元回归分析中，完整甲状旁腺激素（P<0.001）在年龄（P<0.001）和糖尿病（P<0.001）之后是与皮肤自发荧光相关性第三显著的因素。在单变量多项逻辑回归分析中，皮肤自发荧光每增加 1U，CACS≥400 的几率就会增加 7.43 倍（95%置信区间，3.59-15.37；P<0.001）。皮肤自发荧光仍然可以预测 CACS≥400（优势比，3.63；95%置信区间，1.44-9.18；P=0.006），即使在调整年龄、性别、血清钙、磷、白蛋白、C 反应蛋白、脂质、血压、估计肾小球滤过率和完整甲状旁腺激素后，其意义仍然显著，但在进一步调整糖尿病后，其意义略有下降（优势比，2.23；95%置信区间，0.81-6.14；P=0.1）。与没有糖尿病且甲状旁腺激素较低的患者相比，患有糖尿病且甲状旁腺激素较高的患者皮肤自发荧光和 CACS 更高。
皮肤自发荧光所反映的组织晚期糖基化终产物与慢性肾脏病患者的血管钙化有显著的新关联。这些数据表明，组织晚期糖基化终产物的增加可能导致慢性肾脏病和糖尿病患者的血管钙化，需要进一步的实验研究。
