血清sortilin与维持性血液透析患者的冠状动脉钙化及心脑血管事件相关。
Serum Sortilin Is Associated with Coronary Artery Calcification and Cardiovascular and Cerebrovascular Events in Maintenance Hemodialysis Patients.
作者信息
Xu Jie, Shen Chan-Juan, Ooi Joshua D, Tang Yang-Shuo, Xiao Zhou, Yuan Qiong-Jing, Zhong Yong, Zhou Qiao-Ling
机构信息
Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China.
Department of Hematology, The Affiliated Zhuzhou Hospital Xiangya Medical College, Central South University, Zhuzhou, China.
出版信息
Kidney Dis (Basel). 2021 Jul 15;7(6):503-513. doi: 10.1159/000517304. eCollection 2021 Nov.
OBJECTIVE
To analyze the role of serum sortilin in coronary artery calcification (CAC) and cardiovascular and cerebrovascular events (CCE) in maintenance hemodialysis (MHD) patients.
METHODS
One hundred eleven patients with MHD ≥3 months were included in this study. The general data, clinical features, hematological data, and medication history of the patients were recorded. Eighty-five cases were examined by vascular color Doppler ultrasound, cardiac color Doppler ultrasound, lateral lumbar radiography, and coronary artery calcification score. The patients were followed up for a median time of 45 months. The primary endpoint was CCE or death from a vascular event, and the role of sortilin in this process was analyzed.
RESULTS
Among 85 MHD patients, 51 cases (60.00%) had different degrees of CAC. There were significant differences in diabetes, dialysis time, serum phosphorus, calcium-phosphorus product, medical history of phosphate binders, sortilin, and carotid artery plaque between 4 different degrees of calcification groups ( < 0.05). Logistic regression analysis showed that diabetes (OR = 5.475; 95% CI: 1.794-16.71, = 0.003), calcium-phosphorus product (OR = 2.953; 95% CI: 1.198-7.279, = 0.019), and sortilin (OR = 1.475 per 100 pg/mL; 95% CI: 1.170-1.858, = 0.001) were independent risk factors for CAC. During the follow-up, 28 cases of 111 patients (25.23%) suffered from CCE. There were significant differences in CCE between mild, moderate, and severe CAC groups and noncalcification groups ( < 0.05). Cox regression analysis showed that diabetes mellitus (HR 3.424; 95% CI: 1.348-8.701, = 0.010), CAC (HR 5.210; 95% CI: 1.093-24.83, = 0.038), and serum sortilin (HR = 8.588; 95% CI: 1.919-38.43, = 0.005) were independent risk factors for CCE. Besides, we proposed a cutoff value of 418 pg/mL for serum sortilin level, which was able to predict the occurrence of CCE with 75.0% sensitivity and 71.9% specificity. The area under the curve was 0.778 (95% CI: 0.673-0.883).
CONCLUSION
Sortilin is newly found to be independently associated with CAC and CCE in MHD patients.
目的
分析血清sortilin在维持性血液透析（MHD）患者冠状动脉钙化（CAC）及心脑血管事件（CCE）中的作用。
方法
本研究纳入111例MHD时间≥3个月的患者。记录患者的一般资料、临床特征、血液学数据及用药史。85例患者接受了血管彩色多普勒超声、心脏彩色多普勒超声、腰椎侧位X线摄影及冠状动脉钙化评分检查。对患者进行了中位时间为45个月的随访。主要终点为CCE或血管事件死亡，并分析sortilin在此过程中的作用。
结果
85例MHD患者中，51例（60.00%）有不同程度的CAC。4个不同钙化程度组在糖尿病、透析时间、血清磷、钙磷乘积、磷结合剂用药史、sortilin及颈动脉斑块方面存在显著差异（<0.05）。Logistic回归分析显示，糖尿病（OR = 5.475；95%CI：1.794 - 16.71，= 0.003）、钙磷乘积（OR = 2.953；95%CI：1.198 - 7.279，= 0.019）及sortilin（每100 pg/mL的OR = 1.475；95%CI：1.170 - 1.858，= 0.001）是CAC的独立危险因素。随访期间，111例患者中有28例（25.23%）发生CCE。轻度、中度和重度CAC组与非钙化组在CCE方面存在显著差异（<0.05）。Cox回归分析显示，糖尿病（HR 3.424；95%CI：1.348 - 8.701，= 0.010）、CAC（HR 5.210；95%CI：1.093 - 24.83，= 0.038）及血清sortilin（HR = 8.588；95%CI：1.919 - 38.43，= 0.005）是CCE的独立危险因素。此外，我们提出血清sortilin水平的截断值为418 pg/mL，其预测CCE发生的敏感性为75.0%，特异性为71.9%。曲线下面积为0.778（95%CI：0.673 - 0.883）。
结论
新发现sortilin与MHD患者的CAC及CCE独立相关。
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