维持性血液透析患者的血清骨保护素：与死亡率、动脉粥样硬化和心脏功能的关联
Serum osteoprotegerin in prevalent hemodialysis patients: associations with mortality, atherosclerosis and cardiac function.
作者信息
Collado Sílvia, Coll Elisabeth, Nicolau Carlos, Azqueta Manel, Pons Mercedes, Cruzado Josep M, de la Torre Bernat, Deulofeu Ramón, Mojal Sergi, Pascual Julio, Cases Aleix
机构信息
Nephrology Department Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques, C/ Paseo Marítimo, 25-29, 08003, Barcelona, Spain.
Nephrology Department, Fundació Puigvert, Barcelona, Spain.
出版信息
BMC Nephrol. 2017 Sep 7;18(1):290. doi: 10.1186/s12882-017-0701-8.
BACKGROUND
To assess whether serum osteoprotegerin (OPG) and/or fetuin-A predict mortality and cardiovascular (CV) morbidity and mortality in hemodialysis patients.
METHODS
Multicenter, observational, prospective study that included 220 hemodialysis patients followed up for up to 6 years. Serum OPG and fetuin-A levels were measured at baseline and their possible association with clinical characteristics, CV risk biomarkers, carotid ultrasonographic findings, as well as their association with overall and CV mortality and CV events were assessed.
RESULTS
During a mean follow-up of 3.22 ± 1.91 years, there were 74 deaths (33.6%) and 86 new cardiovascular events. In the Kaplan-Meier survival analysis, the highest tertile of OPG levels was associated with higher overall mortality (p = 0.005), as well as a higher, although non-significant, incidence of CV events and CV mortality. In contrast, fetuin-A levels did not predict any of these events. OPG levels were directly associated with age, the Charlson comorbidity index (CCI), prevalent cardiovascular disease, carotid intima-media thickness, adiponectin, troponin-I and brain natriuretic peptide (BNP). OPG showed a negative correlation with left ventricular ejection fraction (LVEF) and phosphate levels. In the multivariate Cox proportional hazard analysis, all-cause mortality was associated with the highest tertile of OPG (HR:1.957, p = 0.018), age (HR:1.031, p = 0.036), smoking history (HR:2.122, p = 0.005), the CCI (HR:1.254, p = 0.004), troponin-I (HR:3.894, p = 0.042), IL-18 (HR:1.061, p < 0.001) and albumin levels (HR:0.886, p < 0.001). In the bootstrapping Cox regression analysis, the best cut-off value of OPG associated with mortality was 17.69 pmol/L (95%CI: 5.1-18.02).
CONCLUSIONS
OPG, but not fetuin-A levels, are independently associated with overall mortality, as well as clinical and subclinical atherosclerosis and cardiac function, in prevalent hemodialysis patients.
背景
评估血清骨保护素（OPG）和/或胎球蛋白-A是否可预测血液透析患者的死亡率、心血管（CV）发病率和死亡率。
方法
多中心、观察性、前瞻性研究，纳入220例血液透析患者，随访长达6年。在基线时测量血清OPG和胎球蛋白-A水平，并评估它们与临床特征、CV风险生物标志物、颈动脉超声检查结果的可能关联，以及它们与总体和CV死亡率及CV事件的关联。
结果
在平均3.22±1.91年的随访期间，有74例死亡（33.6%）和86例新发心血管事件。在Kaplan-Meier生存分析中，OPG水平最高三分位数与较高的总体死亡率相关（p = 0.005），以及较高的CV事件和CV死亡率发生率（虽无统计学意义）。相比之下，胎球蛋白-A水平不能预测这些事件中的任何一项。OPG水平与年龄、Charlson合并症指数（CCI）、心血管疾病患病率、颈动脉内膜中层厚度、脂联素、肌钙蛋白-I和脑钠肽（BNP）直接相关。OPG与左心室射血分数（LVEF）和磷酸盐水平呈负相关。在多变量Cox比例风险分析中，全因死亡率与OPG最高三分位数（HR：1.957，p = 0.018）、年龄（HR：1.031，p = 0.036）、吸烟史（HR：2.122，p = 0.005）、CCI（HR：1.254，p = 0.004）、肌钙蛋白-I（HR：3.894，p = 0.042）、白细胞介素-18（HR：1.061，p < 0.001）和白蛋白水平（HR：0.886，p < 0.001）相关。在自展Cox回归分析中，与死亡率相关的OPG最佳截断值为17.69 pmol/L（95%CI：5.1 - 18.02）。
结论
在血液透析患者中，OPG而非胎球蛋白-A水平与总体死亡率、临床和亚临床动脉粥样硬化及心脏功能独立相关。
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