El Baz Tarek Z, Khamis Osama A, El-Shehaby Amal, Chahine Hussein, Alaa Al-Din Ahmed Ahmad, Alsawasany Mostafa A
Internal Medicine, Faculty of Medicine, AL-Azhar University, Cairo, Egypt.
Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt.
Egypt Heart J. 2017 Jun;69(2):149-155. doi: 10.1016/j.ehj.2017.02.004. Epub 2017 Mar 9.
Uremia is a vasculopathic process, and both cardiac calcification and vascular calcification seen from the early stages of chronic kidney disease. Osteoprotegerin could play a crucial role in atherosclerotic plaque formation, maturation and calcification. The goal of this study was to determine the relationship of serum osteoprotegerin with vascular calcification in patients with end stage kidney disease who were maintained on regular hemodialysis.
Sixty clinically stable chronic renal failure patients undergoing regular hemodialysis were enrolled in this cross sectional study. Thirty patients (mean age 56.7 ± 10.5 years) with abdominal aortic calcification were selected by basal abdominal X-ray who underwent multi-slice computerized tomography scan to measure coronary artery calcification score; and thirty patients (mean age 56.5 ± 8.4 years) without abdominal aortic calcification. All patients were evaluated by serum calcium, phosphorus, albumin, lipid profile, intact parathyroid hormone (iPTH), serum creatinine, serum urea, serum uric acid, serum C-reactive protein, and hemoglobin. Serum osteoprotegerin samples were collected before dialysis and estimated by the ELISA kit.
Serum osteoprotegerin level was significantly higher in patients with vascular calcification than in those without calcifications. Serum osteoprotegerin correlated positively with serum phosphorus, calcium phosphorus product, alkaline phosphatase, iPTH, C-reactive protein, serum uric acid, low-density lipoprotein (LDL) and left ventricular mass index (LVMI) ( < 0.005), and negatively with hemoglobin, ejection fraction ( < 0.005) and HDL ( < 0.05).
These findings suggest that osteoprotegerin may be involved in the development of vascular calcification in hemodialysis patients.
尿毒症是一种血管病变过程，在慢性肾脏病早期即可出现心脏钙化和血管钙化。骨保护素可能在动脉粥样硬化斑块形成、成熟和钙化过程中起关键作用。本研究的目的是确定维持性规律血液透析的终末期肾病患者血清骨保护素与血管钙化之间的关系。
本横断面研究纳入了60例临床稳定的慢性肾衰竭并接受规律血液透析的患者。通过腹部X线平片筛选出30例（平均年龄56.7±10.5岁）有腹主动脉钙化的患者，这些患者接受多层螺旋计算机断层扫描以测量冠状动脉钙化积分；另外30例（平均年龄56.5±8.4岁）无腹主动脉钙化的患者。所有患者均接受血清钙、磷、白蛋白、血脂、完整甲状旁腺激素（iPTH）、血清肌酐、血清尿素、血清尿酸、血清C反应蛋白和血红蛋白的评估。透析前采集血清骨保护素样本，并采用酶联免疫吸附测定试剂盒进行检测。
血管钙化患者的血清骨保护素水平显著高于无钙化患者。血清骨保护素与血清磷、钙磷乘积、碱性磷酸酶、iPTH、C反应蛋白、血清尿酸、低密度脂蛋白（LDL）和左心室质量指数（LVMI）呈正相关（<0.005），与血红蛋白、射血分数呈负相关（<0.005），与高密度脂蛋白（HDL）呈负相关（<0.05）。
这些发现提示骨保护素可能参与血液透析患者血管钙化的发生发展。
