【摘要】 目的观察初始血透患者血清胎球蛋白A水平与冠脉钙化(CAC)的关系。方法 29例初始透析患者(透析龄<6月)接受血清胎球蛋白A及CAC相关危险因子的检测,根据胎球蛋白A平均浓度分胎球蛋白A高水平组和胎球蛋白A低水平组;CAC通过多层螺旋CT检测,钙化积分采用Agaston修正方法 ;对所有29例患者进行心血管事件评价随访,时间为18个月。结果 29例初始透析患者血清胎球蛋白A平均浓度(0.71g/L);胎球蛋白A低水平组中11/14例(78.57%)发生CAC,高于胎球蛋白A高水平组(7/15例,46.67%),P<0.05;CAC积分与血清胎球蛋白A水平呈负相关(Pearson-0.734,P=0.001)。回归分析显示:CAC与胎球蛋白A(标化beta=-0.568,P=0.003)和年龄(标化beta=0.416,P=0.019)有关;钙化的传统危险因素如:CRP,Ca,P,iPTH,Chol,TG,HDL-C,LDL-C,BMI及血压未能进入回归方程,P>0.05。血清胎球蛋白A水平与心血管事件发生呈相关关系(Spearman’srho-0.758,P<0.01),但Kaplan-Meier生存分析显示两组无心血管事件生存率无显著差异(LogRank,P=0.065)。结论血清胎球蛋白A水平下降可能是导致初始透析患者CAC的危险因素,也可能是心血管事件高发的原因之一。更多还原

【Abstract】 Objective To examine the relationship between reduction of serum fetuin A and coronary artery calcification (CAC) in patients starting hemodialysis. Methods Twenty-nine patients on chronic hemodialysis (duration of hemodialysis less than 6 months) were enrolled in this study. Serum fetuin A and such potential CAC-related risk factors as C-reactive protein (CRP), Ca, P, iPTH, body mass index (BMI) were examined. CAC was detected by multislice spiral CT scan (MSCT) and quantified by the modified Agaston’s scoring system. All the 29 patients were followed up for 18 months to appraise the cardiovascular events defined as cardiac failure, angina pectoris or myocardial infarction. Results Eleven patients (78.57%) were found to have CAC as detected by MSCT in low serum fetuin A (below the average serum concentration of 0.71 g/L) group, a rate significantly higher than that in high serum fetuin A group (7 patients, 46.67%, P<0.05). Serum fetuin A in these 29 patients was related with CAC score (Pearson correlation coefficient of-0.734, P=0.001) and stepwise regression analysis indicated that serum fetuin A (standardized beta=-0.568, P=0.003) and age (standardized beta=0.416, P=0.019) were independently correlated to CAC. Such factors as CRP, Ca, P, iPTH, Chol, TG, HDL-C, LDL-C, BMI and blood pressure were excluded from the regression equation. Reduction of serum fetuin A was associated with cardiovascular events (Spearman’s rho-0.758, P<0.01). No significant difference was found between low and high serum fetuin A groups by Kaplan-Meier survival analysis (P=0.065). Conclusion Reduced serum fetuin A may be a potential risk factor of coronary artery calcification, and can contribute to cardiovascular events in patients starting hemodialysis.更多还原