Objective To observe the clinical features of coronary artery calcification (CAC) in peritoneal dialysis (PD) patients, to find out serological markers for evaluating CAC, and to estimate their application values for the diagnosis of CAC. Methods The PD patients treated during March 2022 to March 2023 in the Department of Nephrology, Nanjing Gaochun People's Hospital were recruited for this study. Their clinical data were collected, laboratory examinations were improved, and serum sclerostin, dephospho-uncarboxylated matrix glaprotein (dp-ucMGP) and soluble growth stimulation expressed gene 2 (sST2) were dtermined by ELISA. Spiral CT was used to assess the coronary artery calcification score (CACS). According to CACS, patients were then divided into non-calcified group (CACS=0), mild calcified group (0＜CACS＜100), moderate calcified group (100≤CACS≤400) and severe calcified group (CACS>400). Clinical data and serum indexes were compared among the four groups, and the serological markers were then screened for evaluating CAC. Results The prevalence of CAC was 67.96% (70 cases) in a total of 103 PD patients. There were statistical differences in age (F=9.644, P＜0.001), dialysis age (F=8.141, P=0.043), cardiovascular disease rate (F=8.424, P=0.038), total Kt/V (F=3.775, P=0.013), alkaline phosphatase (F=7.909, P=0.048), sclerostin (F=31.513, P＜0.001), dp-ucMGP (F=24.188, P＜0.001), sST2 (F=8.691, P=0.034), and B-type natriuretic peptide precursor (F=13.922, P=0.003) among the four groups. Multivariate logistic regression showed that older age (OR=1.192, 95% CI：1.070～1.327, P=0.001), low Kt/V (OR=0.006, 95% CI：0.000～0.418, P=0.018), higher sclerotin (OR=1.826, 95% CI：1.194～2.792, P=0.006), and higher dp-ucMGP (OR=1.990, 95% CI：1.235～3.207, P=0.005) were the independent risk factors for CAC. ROC curve analysis showed that the areas under the curve of serum sclerostin, dp-ucMGP and their combined for predicting CAC in PD patients were 0.817 (95% CI: 0.715～0.919, P＜0.001), 0.797 (95% CI：0.705～0.889, P＜0.001), and 0.855 (95% CI：0.776～0.935, P＜0.001) respectively. Conclusion Serum sclerostin and dp-ucMGP levels are potentially sensitive serological markers for predicting CAC in PD patients, having important value for clinical application.
CHENG Hong-Juan
,
ZENG Ming
,
WU Xiao-Rong
,
ZHOU Wei
. Screening and predictive value of serum markers related to coronary artery calcification in peritoneal dialysis patients[J]. Chinese Journal of Blood Purification, 2024
, 23(03)
: 165
-169
.
DOI: 10.3969/j.issn.1671-4091.2024.03.002
参考文献：
[1] 郭静,刘瑞华,余学清等.腹膜透析在老年终末期肾病患者中的临床应用进展[J].中华肾脏病杂志,2022,38(7):634-638.
[2] Lalayiannis AD, Ferro CJ, Wheeler DC, et al. The burden of subclinical cardiovascular disease in children and young adults with chronic kidney disease and on dialysis [J].?Clin Kidney J. 2021;15(2):287-294.
[3] Zununi Vahed S, Mostafavi S, Hosseiniyan Khatibi SM, et al. Vascular Calcification: An Important Understanding in Nephrology [J].?Vasc Health Risk Manag. 2020;16:167-180.
[4] 陈金艳,王潇玥,杜雅静等.维持性腹膜透析患者骨硬化蛋白、Dickkopf-1蛋白水平与冠状动脉钙化的相关性研究[J].中国血液净化,2022,21(10):724-728,784.
[5] Puzantian H, Akers SR, Oldland G, et al. Circulating Dephospho-Uncarboxylated Matrix Gla-Protein Is Associated With Kidney Dysfunction and Arterial Stiffness [J].?Am J Hypertens. 2018;31(9):988-994.
[6] Zhang Y, Fan Z, Liu H, et al. Correlation of plasma soluble suppression of tumorigenicity-2 level with the severity and stability of coronary atherosclerosis [J].?Coron Artery Dis. 2020;31(7):628-635.
[7] Baumann S, Overhoff D, Tesche C,et al. Morphological and functional diagnostics of coronary artery disease by computed tomography [J].?Herz.2022; 10.1007/s00059-022-05098-7.
[8] Zununi Vahed S, Mostafavi S, Hosseiniyan Khatibi SM, et al. Vascular Calcification: An Important Understanding in Nephrology [J].?Vasc Health Risk Manag. 2020;16:167-180.
[9] Zhang H, Li G, Yu X, et al. Progression of Vascular Calcification and Clinical Outcomes in Patients Receiving Maintenance Dialysis.?JAMA Netw Open. 2023;6(5):e2310909.
[10] Nishizawa Y, Mizuiri S, Yorioka N , et al. Determinants of coronary artery calcification in maintenance hemodialysis patients [J].?J Artif Organs. 2015;18(3):251-256.
[11] 郭文利,熊琳,吴蔚桦等.维持性血液透析患者冠状动脉钙化相关血清学标志物的筛选及其相关性分析[J].中国动脉硬化杂志,2023,31(04):336-342.
[12] Jansz TT, van Reekum FE, ?zyilmaz A, et al. Coronary Artery Calcification in Hemodialysis and Peritoneal Dialysis [J].?Am J Nephrol. 2018;48(5):369-377.
[13] Homsak E, Ekart R. ST2 as a novel prognostic marker in end-stage renal disease patients on hemodiafiltration [J].?Clin Chim Acta. 2018;477:105-112.
[14] Ates I, Ozkayar N, Ates H, Karakulak UN, Kursun O, Topcuoglu C, et al.Elevated circulating sST2 associated with subclinical atherosclerosis in newly diagnosed primary hypertension [J]. Hypertens Res. 2016;39:513–518.
[15] 王伟,徐长生,霍昱彰等.老年终末期肾病血液透析患者血清FGF-23、sST2水平变化及对心脏瓣膜钙化的预测价值[J].中国血液净化,2023,22(2):100-104.
[16] Maré A, D'Haese PC, Verhulst A. The Role of Sclerostin in Bone and Ectopic Calcification [J].?Int J Mol Sci. 2020;21(9):3199.
[17] Carrillo-López N, Martínez-Arias L, Fernández-Villabrille S, et al. Role of the RANK/RANKL/OPG and Wnt/β-Catenin Systems in CKD Bone and Cardiovascular Disorde-rs [J].?Calcif Tissue Int. 2021;108(4):439-451.
[18] Xiao Q, Tang Y, Luo H, et al. Sclerostin is involved in osteogenic transdifferentiation of vascular smooth muscle cells in chronic kidney disease-associated vascular calcification with non-canonical?Wnt signaling [J].?Ren Fail. 2022;44(1):1426-1442.?
[19] Ge Y, Wu B, Yu X, et al. Association of Serum Sclerostin Level, Coronary Artery Calcification, and Patient Outcomes in Maintenance Dialysis Patients [J].?Blood Purif. 2022;51(3):260-269.?
[20] Jiqing H, Mingjiao P, Mingzhi X et al. Circulating miRNA-29b and Sclerostin Levels Correlate with Coronary Artery Calcification and Cardiovascular Events in Maintenance Hemodialysis Patients[J] .Cardiol Res Pract, 2021, 2021: 9208634.
[21] De Maré A, Opdebeeck B, Neven E, D'Haese PC, Verhulst A. Sclerostin Protects Against Vascular Calcification Development in Mice [J].?J Bone Miner Res. 2022;37(4):687-699.
[22] Nakagawa Y, Komaba H, Wada T, et al. Serum sclerostin levels and mortality in he-modialysis patients: An 8-year prospective study [J] .Am J Nephrol.2022,53:767-774.
[23] Puzantian H, Akers SR, Oldland G, et al. Circulating Dephospho-Uncarboxylated Matrix Gla-Protein Is Associated With Kidney Dysfunction and Arterial Stiffness [J].?Am J Hypertens. 2018;31(9):988-994.
[24] Delanaye P, Krzesinski JM, Warling X, et al. Dephosphorylated-uncarboxylated Matrix Gla protein concentration is predictive of vitamin K status and is correlated with vascular calcification in a cohort of hemodialysis patients [J].?BMC Nephrol. 2014;15:145.?
[25] Willeit K, Santer P, Tschiderer L, et al. Association of desphospho-uncarboxylated matrix gla protein with incident cardiovascular disease and all-cause mortality: Results from the prospective Bruneck Study [J].?Atherosclerosis. 2022;353:20-27.?
