慢性肾脏疾病患者各期骨形态蛋白-2水平变化及其影响因素

摘要

目的 探讨慢性肾脏疾病(chronic kidney disease,CKD)1-5期患者血清骨形态蛋白-2 (Bone morphogenetic protein 2,BMP-2)水平变化及其可能的影响因素. 方法 收集CKD各期的154例血液样本.测定血清BMP-2水平和常规生化测定肾功能、白蛋白、C-反应蛋白(CRP)及钙磷代谢等.并进行相关及多元回归分析. 结果 CKD1～5期各有26、22、26、20、28例,血液透析32例,对照28例.与正常对照比较,CKD4,CKD5期及血液透析患者血清BMP-2水平明显升高;血清BMP-2水平在CKD患者下列情况下显著升高:血磷大于1.4mmol/L或钙磷沉积大于55 mg2/d12;血清白蛋白低于35g/L；C-反应蛋白大于3000 μ g/L.相关分析结果提示,BMP-2与血磷水平,钙磷乘积,C-反应蛋白,血尿素氮,血肌酐呈显著正相关；与血清白蛋白和肾小球滤过率呈显著负相关.多元回归分析示:血磷及CRP显著影响BMP-2的独立因素. 结论 BMP-2在CKD中晚期和血液透析患者血清中明显升高;残存肾功能、钙磷代谢、炎症和白蛋白可能与CKD患者血清BMP-2水平有关;血磷和炎症是影响BMP-2的主要因素.%Objectives To investigate the variation of serum bone morphogenetic protein 2 (BMP-2),and the influences of eGFR,calcium-phosphate metabolism,inflammmation,lipid profile and nutrition index on BMP-2 production in chronic kidney disease (CKD) patients at different stages.Methods A cross-sectional study was performed in 154 CKD patients at different stages.BMP-2 was measured by ELISA,and other biochemistry parameters were assyed as well.Results We enrolled 26,22,26,20,and 28 CKD patients at the stage of 1,2,3,4and 5,respectively,and 32 CKD patients on maintenance hemodialysis (MHD) in this study.Twenty-eight healthy subjects were used as normal controls.(a) Serum BMP-2 increased significantly in CKD patients at stages of 4 and 5 and in those on MHD.(b) Serum BMP-2 was siginificant higher in CKD patients with plasma phosphate ＞1.4 mmol/l or Ca × p product ＞55 mg2/dl2,serum albumin ＜35 g/L,or CRP ＞3000 μg/L.(c) Serum BMP-2 level was positively correlated to serum phosphate,calcium × phosphate product,CRP,BUN and creatinine,and negatively correlated to serum albumin and eGFR.Multiple regression analysis demonstrated that serum phosphate and CRP were the independent factors relating to serum BMP-2 level.Conclusions Serum BMP-2 increased significantly in CKD patients at advanced stage and on MHD,and was also correlated to their residual renal function,calcium-phosphate metabolism,inflammation,and plasma albumin.