维持性血液透析患者血清可溶性α-klotho水平与腹主动脉钙化有关。
Serum Soluble Klotho Level Is Associated with Abdominal Aortic Calcification in Patients on Maintenance Hemodialysis.
作者信息
Cai Hong, Lu Renhua, Zhang Mingfang, Pang Huihua, Zhu Mingli, Zhang Weiming, Ni Zhaohui, Qian Jiaqi, Yan Yucheng
出版信息
Blood Purif. 2015;40(2):120-6. doi: 10.1159/000381937.
BACKGROUND
Klotho is a single transmembrane protein originally identified as an ‘aging suppressor'. Emerging evidence reveals that soluble Klotho (sKl) in the circulation plays important roles in anti-aging, anti-oxidation, anti-apoptosis and Wnt signaling. However, the role of serum sKl in the vascular calcification in hemodialysis patients is not clear. The aim of this study was to determine the associations of sKl with abdominal aortic calcification in patients on maintenance hemodialysis (MHD).
METHODS
129 MHD patients were enrolled prospectively. Serum sKl level was detected by ELISA. Abdominal aortic calcification was measured by abdomen lateral plain radiograph, and the abdominal aorta calcification (AAC) score was calculated. The sKl levels were observed in patients with different degrees of calcification. Logistic regression analysis was used to determine the risk factor of abdominal aortic calcification in MHD patients. The diagnostic value of sKl for abdominal aortic calcification was assessed using receiver operator characteristic (ROC).
RESULTS
Abdominal aortic calcification was seen in 87 of 129 patients. The median AAC score was 4.0 (0.00, 11.00) and the median sKl level was 616.29 (378.19, 821.61) pg/ml. Serum sKl levels were inversely associated with AAC. When evaluated as AAC categories (<5, 5-15, >15) with ordinal logistic regression, each SD higher sKl was associated with 37.1% lower odds of AAC severity (proportional odds ratio: 0.629; 95% confidence interval: 0.413-0.959, p = 0.031) in models adjusted for demographic data, lifestyle factors, traditional CVD risk factors and uremic risk factors. Multivariate logistic regression analysis showed that serum sKl levels and smoking were independent risk factors for severe AAC. The area under the receiver-operating characteristic curve (AUC) of serum sKl for severe abdominal aortic calcification was 0.746 (0.612-0.880, p = 0.001), sensitivity was 0.885, and specificity was 0.562 for a cutoff value of 265.39 pg/ml.
CONCLUSIONS
Lower serum sKl levels are independently associated with severe AAC. Serum sKl might have a diagnostic value for the severe AAC in MHD patients.
背景
α-klotho是一种单跨膜蛋白，最初被鉴定为“衰老抑制因子”。新出现的证据表明，循环中的可溶性α-klotho（sKl）在抗衰老、抗氧化、抗凋亡和Wnt信号传导中发挥重要作用。然而，血清sKl在血液透析患者血管钙化中的作用尚不清楚。本研究的目的是确定维持性血液透析（MHD）患者中sKl与腹主动脉钙化的关联。
方法
前瞻性纳入129例MHD患者。采用酶联免疫吸附测定法（ELISA）检测血清sKl水平。通过腹部侧位X线平片测量腹主动脉钙化情况，并计算腹主动脉钙化（AAC）评分。观察不同钙化程度患者的sKl水平。采用逻辑回归分析确定MHD患者腹主动脉钙化的危险因素。使用受试者工作特征（ROC）曲线评估sKl对腹主动脉钙化的诊断价值。
结果
129例患者中有87例出现腹主动脉钙化。AAC评分中位数为4.0（0.00，11.00），sKl水平中位数为616.29（378.19，821.61）pg/ml。血清sKl水平与AAC呈负相关。在按序逻辑回归评估为AAC类别（<5、5 - 15、>15）时，在调整了人口统计学数据、生活方式因素、传统心血管疾病（CVD）危险因素和尿毒症危险因素的模型中，sKl每升高1个标准差，AAC严重程度的比值比降低37.1%（比例优势比：0.629；95%置信区间：0.413 - 0.959，p = 0.031）。多因素逻辑回归分析显示，血清sKl水平和吸烟是严重AAC的独立危险因素。血清sKl对严重腹主动脉钙化的受试者工作特征曲线下面积（AUC）为0.746（0.612 - 0.880，p = 0.001），对于截断值265.39 pg/ml，敏感性为0.885，特异性为0.562。
结论
较低的血清sKl水平与严重AAC独立相关。血清sKl可能对MHD患者的严重AAC具有诊断价值。
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