Department of Internal Medicine, Catholic Kwandong University International Saint Mary's Hospital, Incheon, Republic of Korea.
Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
J Nephrol. 2023 Sep;36(7):2091-2109. doi: 10.1007/s40620-023-01732-7. Epub 2023 Sep 26.
The impact of circulating sclerostin levels on vascular calcification has shown conflicting results depending on the target population and vascular anatomy. This study investigated the associations of sclerostin levels with vascular outcomes in kidney transplant patients.
In a prospective observational study of the Korean Cohort Study for Outcome in Patients with Kidney Transplantation, 591 patients with serum sclerostin level data prior to transplantation were analyzed. The main predictor was the pre-transplant sclerostin level. Vascular outcomes were the abdominal aortic calcification score and brachial-ankle pulse wave velocity measured at pre-transplant screening and three and five years after kidney transplantation.
In linear regression analysis, sclerostin level positively correlated with changes in abdominal aortic calcification score between baseline and five years after kidney transplantation (coefficient of 0.73 [95% CI, 0.11-1.35] and 0.74 [95% CI, 0.06-1.42] for second and third tertiles, respectively, vs the first tertile). In a longitudinal analysis over five years, using generalized estimating equations, the coefficient of the interaction (sclerostin × time) was significant with a positive value, indicating that higher sclerostin levels were associated with faster increase in post-transplant abdominal aortic calcification score. Linear regression analysis revealed a positive association between pre-transplant sclerostin levels and changes in brachial-ankle pulse wave velocity (coefficient of 126.7 [95% CI, 35.6-217.8], third vs first tertile). Moreover, a significant interaction was identified between sclerostin levels and brachial-ankle pulse wave velocity at five years.
Elevated pre-transplant sclerostin levels are associated with the progression of post-transplant aortic calcifications and arterial stiffness.
循环中骨硬化蛋白水平对血管钙化的影响因目标人群和血管解剖结构的不同而结果不一。本研究旨在探讨移植前骨硬化蛋白水平与肾移植患者血管结局的相关性。
在一项对韩国肾移植患者结局的前瞻性观察性研究中，分析了 591 例移植前有血清骨硬化蛋白水平数据的患者。主要预测指标为移植前的骨硬化蛋白水平。血管结局为移植前筛查时以及移植后 3 年和 5 年测量的腹主动脉钙化评分和肱踝脉搏波速度。
在线性回归分析中，骨硬化蛋白水平与移植后 5 年内腹主动脉钙化评分的变化呈正相关（第二和第三三分位组与第一三分位组相比，系数分别为 0.73[95%CI，0.11-1.35]和 0.74[95%CI，0.06-1.42]）。在 5 年的纵向分析中，使用广义估计方程，交互项（骨硬化蛋白×时间）的系数具有统计学意义，且为正值，表明较高的骨硬化蛋白水平与移植后腹主动脉钙化评分的增加速度更快相关。线性回归分析显示，移植前骨硬化蛋白水平与移植后肱踝脉搏波速度的变化呈正相关（系数为 126.7[95%CI，35.6-217.8]，第三三分位与第一三分位相比）。此外，还发现移植前骨硬化蛋白水平与 5 年时的肱踝脉搏波速度之间存在显著的交互作用。
移植前骨硬化蛋白水平升高与移植后主动脉钙化和动脉僵硬度的进展有关。
