【摘要】 目的 探讨维持性血液透析（maintenance hemodialysis,MHD）患者血清核因子NF-κB受体活化因子配体（receptor activator of NF-κB ligand,RANKL）、骨保护素（osteoprotegerin,OPG）及成纤维细胞生长因子21(fibroblast growth factor 21,FGF21)浓度与冠状动脉钙化及其进展的关系。方法 选取2018年1月至2020年12月在广东省人民医院进行MHD的患者178例，收集患者基本资料，利用酶联免疫吸附试验法（enzymelinked immunosorbent assay,ELISA）检测血清OPG、RANKL、FGF21浓度，使用多层螺旋计算机断层扫描（multislice spiral computed tomography,MSCT）测定冠状动脉钙化积分（coronary artery calcification score,CACs），行相关性分析。结果 178例MHD患者重度冠状动脉钙化（CACs> 400分）发生率为54.5%。与轻度冠状动脉钙化（10分<CACs <400分）比较，重度冠状动脉钙化组的血清OPG浓度显著升高，差异有统计学意义（P<0.05）。Spearman相关分析显示OPG与CACs成正相关关系（r=0.217,P=0.004）;OPG对重度冠状动脉钙化的受试者工作特征曲线（receiver operating characteristic curve,ROC）的曲线下面积为0.66。RANKL、FGF21浓度在不同钙化分组患者间比较，差异无统计学意义（P<0.05）。透析患者血清FGF21浓度较健康人群显著升高，约11倍左右，差异有统计学意义（P=0.000）。结论 MHD患者重度冠状动脉钙化发生率高血清OPG浓度与冠状动脉钙化严重程度相关，是评估MHD患者冠状动脉钙化进展的较良好指标。更多还原

【Abstract】 Objectives ligand(RANKL),osteoprotegerin(OPG),fibroblast growth factor 21(FGF21)and coronary artery calcification in patients with maintenance hemodialysis(MHD).Methods Guangdong Provincial People′s Hospital from January 2018 to December 2020 were collected retrospectively. The serum concentrations of OPG,RANKL and FGF21 were detected by enzyme-linked immunosorbent assay(ELISA),and the coronary artery calcification score(CACs)was measured by multislice spiral computed tomography(MSCT).Results The incidence of severe coronary artery calcification(CACs > 400)was 54.5%. In comparison with the light coronary artery calcification group(10<CACs<400),serum concentration of OPG was significantly higher in severe coronary artery calcification group(CACs > 400). Spearman correlation analysis showed that OPG positively correlated with CACs. Receiver operating characteristic curve(ROC)revealed that the area under the curve(AUC)was 0.66 for serum concentration of OPG in diagnosis of severe coronary calcification. There was no significant difference in serum concentrations of RANKL and FGF21 in patients without coronary artery calcification,with mild coronary artery calcification and severe coronary artery calcification. Serum concentration of FGF21 in dialysis patients was significantly higher than that in healthy subjects,about 11-fold(P=0.000).Conclusions high in patients with MHD,and the serum concentration of OPG correlates with the severity of coronary calcification. It is a good index to evaluate the progression of coronary artery calcification in patients with MHD.更多还原