目的 研究腹膜透析(peritoneal dialysis，PD)患者血清骨硬化蛋白(sclerostin)、Dickkopf-1(DKK-1)蛋白水平与冠状动脉钙化程度的相关性。 方法 临床选取行PD[持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis，CAPD)或日间非卧床腹膜透析(daytime ambulatory peritoneal dialysis，DAPD)]＞3个月的患者111例，通过多层螺旋CT结果参照Agatston评分法计算其冠状动脉钙化积分(coronary artery calcium scoring,CaCS)，应用酶联免疫法检测血清sclerostin、DKK-1水平。Logistic回归分析法分析维持性腹膜透析患者冠状动脉钙化的影响因素。应用受试者工作特征曲线(ROC)评价血清sclerostin、DKK-1水平预测腹膜透析患者冠状动脉钙化的准确性与特异性。 结果 111例腹膜透析患者中，发生冠状动脉钙化患者72例(64.9%)，CaCS高分钙化组23例(27.3%)，低分钙化组49例(37.6%)。血Sclerostin(ρ=0.733，P＜0.001)、DKK-1蛋白(ρ=0.796，P＜0.001)水平与CaCS呈正相关。Logistic回归分析结果显示血清sclerostin水平升高(OR =1.052，95% CI：1.005～1.102，P =0.021)、血清DKK-1蛋白水平升高(OR =1.878，95% CI：1.199～2.942，P =0.005)是腹膜透析患者发生冠状动脉钙化的独立危险因素。ROC曲线下面积(AUC)显示血清DKK-1蛋白水平预测腹膜透析患者冠状动脉钙化的AUC为0.960(95% CI：0.927～0.993，P＜0.001,截点为37.05μg/ml，其敏感性为0.875，特异性为0.949)，sclerostin为0.940(95% CI：0.899～0.981，P＜0.001，截点为240pg/ml，其敏感性为0.833，特异性为0.974)。 结论 维持性腹膜透析患者血清骨硬化蛋白、DKK-1蛋白水平升高与发生冠状动脉钙化显著相关，可能参与冠状动脉钙化的发生发展。
Objective To analyze the relationship between serum sclerostin and dickkopf-1 (DKK-1) levels and coronary artery calcification (CAC) in peritoneal dialysis (PD) patients. Methods A total of 110 patients with continuous ambulatory peritoneal dialysis (CAPD) or daytime ambulatory peritoneal dialysis (DAPD) for more than 3 months were prospectively recruited. The coronary calcification score (CaCS) was calculated using the Agatston score from multi-slice spiral CT. Serum sclerostin and Dkk-1 were measured using ELISA. Logistic regression analysis was used to determine the risk factor for CAC in PD patients. Receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of sclerostin and DKK-1 levels for CAC. Results CAC was found in 72 (64.9%) patients, of which 23 CAC patients (27.3%) had higher CaCS, and 49 CAC patients (37.6%) had lower CaCS. Serum sclerostin and DKK-1 levels were positively correlated with moderate to severe CaCS (ρ=0.733, P＜0.001; ρ=0.796, P＜0.001). Logistic regression showed that higher serum sclerostin level (OR＝1.052, 95% CI:1.005～1.102, P=0.021) and higher DKK-1 level (OR=1.180, 95% CI:1.040～1.339, P=0.005) were the independent risk factors for CAC in PD patients. When the cut-off value of serum sclerostin was set at 240pg/ml, the area under curve (AUC) was 0.940 (95% CI:0.899～0.981, P＜0.001), the accuracy was 0.833 and the specificity was 0.974; when the cut-off value of serum DDK-1 was set at 37.05μg/ml, the area under curve (AUC) was 0.960 (95% CI 0.927～0.993, P＜0.001), the accuracy was 0.875 and the specificity was 0.949. Conclusion Higher serum sclerostin and DKK-1 levels are significantly associated with CAC in PD patients. Serum sclerostin and DKK-1 may play important roles in the pathogenesis of CAC in PD patients.
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