目的 分析钙蛋白颗粒(calciprotein particles,CPPs)与慢性肾脏病(chronic kidney disease，CKD)G3～5D期冠状动脉钙化的相关性，探讨CPPs分别对于血液透析(hemodialysis,HD)和非HD患者冠状动脉钙化的预测价值以及影响因素。 方法 本研究采用单中心、横断面调查方法纳入CKD G3～5D患者75例，根据CKD分期分层、冠状动脉钙化积分 (coronary artery calcification score，CACS)分组，将患者分为钙化组和无钙化组，比较CKD各期2组间CPPs的差异。应用二元Logistics回归分析CKD G3～5期(非透析)冠状动脉钙化的危险/保护因子。Kruskal-Wallis检验和Pearson卡方检验评估CPPs与HD冠状动脉钙化严重程度的关系。应用单因素线性回归分析CKD G3～5D期冠状动脉钙化人群CPPs的影响因素。 结果 二元Logistics回归分析结果显示CPPs(每SD增加)是CKD G3～5期(非透析)冠状动脉钙化的独立保护因素，CPPs浓度每增加1个SD(10.20)与冠状动脉钙化风险降低73.4%相关(OR=0.266，95% CI:0.077～0.916，P =0.036)。Kruskal-Wallis检验结果显示CPPs随着冠状动脉钙化严重程度升高(H =6.557,P=0.037)，同时CACS水平随着CPPs增多而升高(H=7.440，P=0.024)。Pearson卡方检验结果显示相比于低水平CPPs组，中、高水平CPPs组高度冠状动脉钙化的HD人群(CACS＞100)占比更大，3组之间不同钙化严重程度的人群比例差异具有统计学意义(χ2=9.800，P=0.044)。单因素线性回归分析结果显示在CKD G3～5D期冠状动脉钙化患者中，CPPs与eGFR-EPI呈负相关(β=-0.424，P=0.004)，与血肌酐(β=0.453，P＜0.001)、血钙(β=0.328，P=0.014)呈正相关。 结论 CPPs是CKD G3～5期(非透析)患者冠状动脉钙化的保护因子，与之相反，对于HD患者，CPPs越高提示冠状动脉钙化严重程度越高。eGFR-EPI、血肌酐、血钙可能是是CKD G3～5D期冠状动脉钙化患者CPPs变化的影响因素。
Objectives To analyze the correlation between calciprotein particles (CPPs) and coronary calcification in chronic kidney disease (CKD) G3～5D patients, and to discuss the predictive value and influencing factors of CPPs for coronary calcification in both hemodialysis (HD) and non-HD patients. Method This single-centered and cross-sectional survey study enrolled 75 CKD G3～5D patients. Based on CKD stage and coronary artery calcification score (CACS), the patients were divided into calcification group and non-calcification group to compare the differences of CPPs at different CKD stages between the two groups. The risk and protective factors for calcification in CKD G3～5 (non-dialysis) patients were assessed using bivariate logistic regression. The correlation between CPPs and degrees of coronary calcification in HD patients was evaluated using Kruskal-Wallis test and Pearson chi square test. The influencing factors for CPPs in CKD G3～5D patients with calcification were investigated using univariate linear regression. Result For CKD G3～5 (non-dialysis) patients, bivariate logistic regression showed that CPPs (increased per SD) were the independent protective factors for coronary calcification; an increase of one SD (10.20) of CPPs was associated with a 73.4% reduction in coronary calcification risk (OR: 0.266, 95% CI: 0.077～0.916, P=0.036). Kruskal-Wallis test showed that CPPs increased with the increase of CACS (H=6.557, P=0.037), and CACS increased with the increase of CPPs (H=7.440, P=0.024). Pearson chi square test demonstrated that the proportion of HD patients with CACS >100 was more in the middle and high CPPs groups than that in the low CPPs group, and the ratios of calcification degrees were statistically different among the 3 CPPs groups (χ2=9.800， P=0.044). Univariate linear regression showed a negative correlation between CPPs and eGFR-EPI (β=-0.424, P=0.004) and positive correlations between CPPs and serum levels of Scr (β=0.453, P＜0.001) and calcium (β=0.328, P=0.014) in CKD G3～5D patients with coronary calcification. Conclusion In CKD G3～5 (non-dialysis) patients, CPPs are the protective factors for coronary calcification. In contrast in HD patients, higher CPPs implies severer coronary calcification. Serum levels of eGFR-EPI, Scr and calcium are the potential factors for CPPs changes in CKD G3～5D patients with coronary calcification.
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