Department of Internal Medicine, Tzaneio General Hospital of Piraeus, 1, Afentouli Str, 18536 Piraeus, Greece.
Renal Dialysis Unit, Nephrolife Clinic, 30, El. Venizelou Str, 16675 Glyfada, Greece.
Diabetes Res Clin Pract. 2017 Aug;130:252-257. doi: 10.1016/j.diabres.2017.06.015. Epub 2017 Jun 19.
The risk of cardiovascular disease (CVD) and mortality is increased in patients with chronic kidney disease (CKD), with a background role of vascular calcification in the development of CVD also reported. Studies have demonstrated that high lipoprotein(a) (Lp(a)) levels accelerate the development of atherosclerolsis and are potentially involved in the vascular calcification. Matrix Gla Protein (MGP) seems to play an important role in vascular calcification. The aim of the study was to examine the potential association of MGP concentrations with Lp(a) and insulin resistance.
The study involved 100patients divided in four groups: 25 with both CKD stage 4 and Type2 Diabetes (DM) (Group-A), 25 with CKD4 without DM (Group-B), 25 non uremic patients with DM (Group-C) and 25 healthy subjects (Group-D). Serum glucose, Lp(a), MGP, plasma HBA1c and insulin were measured in all patients. Insulin resistance was estimated by the homeostasis model assessment equation (HOMA-IR).
A significant positive linear association between MGP and Lp(a) levels (r=0.272, p=0.006) was noted, as well as between MGP and HOMA-IR levels (r=0.308, p=0.002). However, no significant linear association between Lp(a) and HOMA-IR levels was recorded. A similar positive association between MGP and insulin levels (r=0.204, p=0.042) was also found.
This study concluded that diabetes coexisting with renal disease leads to extreme vascular calcification expressed by elevated MGP levels, resulting in higher frequency of cardiovascular disease in comparison to CKD patients without diabetes. The detected Lp(a) and MGP association in CKD4 patients may also represent the key to the complicated mechanism of their coexisting accelerated atherosclerosis and vascular calcification.
患有慢性肾脏病（CKD）的患者心血管疾病（CVD）和死亡率的风险增加，血管钙化在 CVD 的发展中也起着潜在的作用。研究表明，高脂蛋白（a）（Lp（a））水平加速了动脉粥样硬化的发展，并可能与血管钙化有关。基质 Gla 蛋白（MGP）似乎在血管钙化中起重要作用。本研究旨在探讨 MGP 浓度与 Lp（a）和胰岛素抵抗的潜在相关性。
本研究纳入了 100 名患者，分为四组：25 名 CKD 4 期合并 2 型糖尿病（DM）患者（A 组），25 名 CKD4 期无 DM 患者（B 组），25 名非尿毒症 DM 患者（C 组）和 25 名健康受试者（D 组）。所有患者均检测血清葡萄糖、Lp（a）、MGP、血浆 HBA1c 和胰岛素。采用稳态模型评估方程（HOMA-IR）估计胰岛素抵抗。
MGP 与 Lp（a）水平呈显著正线性相关（r=0.272，p=0.006），MGP 与 HOMA-IR 水平呈显著正线性相关（r=0.308，p=0.002）。然而，Lp（a）与 HOMA-IR 水平之间无显著线性相关性。MGP 与胰岛素水平之间也存在类似的正相关关系（r=0.204，p=0.042）。
本研究表明，糖尿病合并肾脏疾病导致血管钙化极度增加，表现为 MGP 水平升高，导致心血管疾病的发生频率高于无糖尿病的 CKD 患者。在 CKD4 患者中检测到的 Lp（a）和 MGP 之间的关联也可能代表其同时存在的加速动脉粥样硬化和血管钙化的复杂机制的关键。
