Rodrigues Fernanda Guedes, Ormanji Milene Subtil, Pietrobom Igor Gouveia, Matos Ana Cristina Carvalho de, De Borst Martin H, Heilberg Ita Pfeferman
Nutrition Post Graduation Program, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil.
Department of Nephrology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
J Clin Med. 2023 Jul 31;12(15):5027. doi: 10.3390/jcm12155027.
Sclerostin plays an important role in bone metabolism and adipose tissue. Animal studies suggest that sclerostin influences urinary calcium (UCa), but this relationship has not been evaluated in stone formers (SFs). We aimed to investigate the association of UCa with serum sclerostin, bone mineral density (BMD), and body composition among SFs.
Clinical and laboratorial data were retrieved from medical records. Determinants of UCa were studied using linear regression.
A total of 107 SFs (35.8 ± 9.3 years, 54% male) with eGFR 99.8 ± 14.5 mL/min/1.73 were studied. Subjects were split by sex and grouped into tertiles of UCa levels. Men in the highest UCa tertile had higher body mass index (BMI) and serum sclerostin, lower lean mass, and a trend towards higher fat mass. Women in the highest tertile had higher BMI and a trend towards higher serum sclerostin. Hypertension and metabolic syndrome, but not lower BMD, were more prevalent in the highest UCa tertile for both sexes. Sclerostin was positively correlated with fat mass and inversely correlated with lean mass among men, but not among women. BMD corrected for BMI at lumbar spine was inversely associated with UCa in a univariate analysis, but only serum sclerostin, hypertension, and NaCl intake were independent determinants of UCa in the multivariate model.
The present findings disclose that in addition to hypertension and salt intake, serum sclerostin is associated with urinary calcium in stone formers, suggesting that in addition to the hormones traditionally thought to alter calcium reabsorption in the kidney, sclerostin may play a significant additional role, warranting further investigation.
骨硬化蛋白在骨代谢和脂肪组织中发挥重要作用。动物研究表明骨硬化蛋白会影响尿钙，但这种关系尚未在结石形成者（SFs）中得到评估。我们旨在研究结石形成者中尿钙与血清骨硬化蛋白、骨密度（BMD）和身体成分之间的关联。
从病历中检索临床和实验室数据。使用线性回归研究尿钙的决定因素。
共研究了107名估算肾小球滤过率（eGFR）为99.8±14.5 mL/min/1.73的结石形成者（年龄35.8±9.3岁，54%为男性）。受试者按性别分组，并根据尿钙水平分为三分位数。尿钙最高三分位数组的男性体重指数（BMI）和血清骨硬化蛋白更高，瘦体重更低，且脂肪量有升高趋势。尿钙最高三分位数组的女性BMI更高，血清骨硬化蛋白有升高趋势。高血压和代谢综合征在尿钙最高三分位数组中更为普遍，而两性的骨密度降低情况并非如此。男性中骨硬化蛋白与脂肪量呈正相关，与瘦体重呈负相关，而女性中并非如此。在单变量分析中，腰椎校正BMI后的骨密度与尿钙呈负相关，但在多变量模型中，只有血清骨硬化蛋白、高血压和氯化钠摄入量是尿钙的独立决定因素。
目前的研究结果表明，除高血压和盐摄入量外，血清骨硬化蛋白与结石形成者的尿钙有关，这表明除了传统上认为会改变肾脏钙重吸收的激素外，骨硬化蛋白可能还起着重要的额外作用，值得进一步研究。
