Department of Rheumatology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No.107, West Culture Road, Lixia District, Jinan, 250012, China.
Department of Rheumatology, Qilu Hospital, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Jinan, China.
Arthritis Res Ther. 2023 Aug 16;25(1):149. doi: 10.1186/s13075-023-03137-0.
While it is known that klotho has negative regulatory effects in a variety of diseases such as metabolic disorders and kidney disease, the specific role of klotho in rheumatoid arthritis (RA) and its effect on mortality are unclear. This study investigated the association between serum klotho levels and mortality in patients with RA.
This study included 841 adults with RA from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016 to extract the concentrations of serum klotho. The association between klotho and RA was determined using Cox regression, Kaplan-Meier (KM) curves, and restricted cubic spline (RCS) models.
A total of 841 patients with RA were included in this study, who were divided into four groups based on the quartiles of serum klotho levels (Q1, Q2, Q3, and Q4). Cox regression analysis with adjustment for covariates revealed that high levels of klotho lowered the risk of both all-cause and cardiovascular mortality compared to the Q1 group. The KM curve analysis suggested that this effect was more pronounced for all-cause mortality. The RCS-fitted Cox regression model indicated a U-shaped correlation between serum klotho levels and RA mortality. The risk of all-cause mortality increased with decreasing serum klotho levels below a threshold of 838.81 pg/mL. Subgroup analysis revealed that the protective effect of klotho was more pronounced in patients with the following characteristics: male, white ethnicity, age ≥ 60 years, body mass index < 25 kg/m, estimated glomerular filtration rate ≥ 60 mL/ (min × 1.73 m), and 25-hydroxyvitamin D level ≥ 50 nmol/L.
Serum klotho levels had a U-shaped correlation with all-cause mortality in patients with RA, indicating that maintain a certain level of serum klotho could prevent premature death.
已知 klotho 在代谢紊乱和肾脏疾病等多种疾病中具有负向调节作用，但 klotho 在类风湿关节炎（RA）中的具体作用及其对死亡率的影响尚不清楚。本研究旨在探讨血清 klotho 水平与 RA 患者死亡率之间的关系。
本研究纳入了 2007 年至 2016 年来自全国健康和营养检查调查（NHANES）的 841 例 RA 成年患者，提取血清 klotho 浓度。使用 Cox 回归、Kaplan-Meier（KM）曲线和限制立方样条（RCS）模型确定 klotho 与 RA 之间的关系。
本研究共纳入 841 例 RA 患者，根据血清 klotho 水平的四分位数（Q1、Q2、Q3 和 Q4）将其分为四组。经协变量调整的 Cox 回归分析显示，与 Q1 组相比，高水平的 klotho 降低了全因和心血管死亡率的风险。KM 曲线分析表明，这种效应在全因死亡率方面更为明显。RCS 拟合的 Cox 回归模型表明，血清 klotho 水平与 RA 死亡率之间呈 U 形相关。血清 klotho 水平低于 838.81 pg/mL 时，全因死亡率的风险随着 klotho 水平的降低而增加。亚组分析表明，klotho 的保护作用在以下特征的患者中更为明显：男性、白种人、年龄≥60 岁、体重指数<25 kg/m2、估计肾小球滤过率≥60 mL/（min×1.73 m）和 25-羟维生素 D 水平≥50 nmol/L。
血清 klotho 水平与 RA 患者的全因死亡率呈 U 形相关，表明维持一定水平的血清 klotho 可能预防过早死亡。
