骨特异性分子标志物与慢性肾脏病患者蛋白质—能量消耗的关系

摘要

Objective To investigate into the relationship between serum and RNA levels of bone specific molecular markers of FGF23,Pin1,Wnt1,β-catenin,DKK1 and protein-energy wasting (PEW) in patients with chronic kidney disease (CKD).Methods A total of 113 patients with CKD were enrolled in this study.The incidence of PEW was statistically analyzed and divided into PEW and non-PEW groups to compare the baseline data including age,sex,body mass index (BMI),albumin (ALB),cholesterol (CHO),serum creatinine (Scr),estimated glomerular filtration rate (eGFR),parathyroid hormone (PTH),vitamin D (Vit D),and comorbidities such as weight and dietary decline,diabetes,hypertension,and cardiovascular disease.Logistic univariate and multivariate regression analysis were used to examine the risk of PEW for the five markers,and the relationship between them was analyzed through Pearson correlation analysis.Results Compared with the non-PEW group,there was a significant decrease in ALB,TCHO,eGFR in PEW group (P ＜ 0.05),while the Scr increased (P ＜ 0.05),and the proportion of patients with weight loss,dietary intake,or diabetes mellitus and cardiovascular disease in PEW group was higher (P ＜ 0.05).Pearson correlation analysis showed that serum FGF-23 concentrations were significantly and positively correlated with PEW (r=0.281,P=0.049).Univariate logistic regression analysis and multivariate logistic regression analysis showed that serum FGF23 and Wntl were an independent predictor of PEW.The area under ROC curve was used to estimate the diagnostic critical value of PEW and the area under ROC curve serum FGF23 was 0.659,and the area under ROC curve serum Wntl was 0.593.In contrast,no correlation was found between the five markers in RNA levels and PEW.Conclusion The incidence of PEW is gradually increased with the progress of CKD.FGF23 is expected to be a serological marker of early diagnosis of PEW,while the relationship of Wnt signaling pathway associated proteins and PEW requires further study for confirmation.%目的 探索慢性肾脏疾病(CKD)患者血清及RNA水平下骨特异性分子标志物FGF23、Pin1、Wnt1、p-catenin、DKK1与蛋白质—能量消耗(PEW)的关系.方法 选取113例CKD患者,统计PEW发生率,并按照PEW发生与否,分为PEW组和非PEW组,组间比较以下指标:一般资料(性别、年龄、身体质量指数),生化指标(血清白蛋白(ALB)、血清总胆固醇(TCHO)、估计肾小球滤过率(eGFR)、血清肌酐(Scr)、甲状旁腺激素、维生素D)及合并症(体重及膳食减少、糖尿病、高血压、心脏疾病).血清及RNA水平下上述5种骨特异性分子标志物与PEW的关系采用单因素及多因素Logistic回归分析法,其与PEW的相关性采用Pearson相关分析.结果 与非PEW组比较,PEW组生化指标ALB、CHO、eGFR降低,Scr升高(P＜0.05);PEW组中伴随体重下降、膳食摄入减少,合并糖尿病、合并心脏疾病的患者比例高于非PEW组(P＜0.05).血清水平下FGF23在PEW组高于非PEW组(P=0.05).Pearson相关分析显示,血清水平下FGF23与PEW呈正相关(r=0.281,P=0.049).单因素及多因素Logistic回归分析表明,血清FGF23和Wnt1水平分别是PEW的风险因素,血清水平下FGF23与PEW的ROC曲线下面积为0.659,血清水平下Wnt1与PEW的ROC曲线下面积为0.593,均具有一定诊断价值.RNA水平下的各标志物均与PEW无相关性.结论 随着CKD的进展,PEW的发生率逐渐增加.骨特异性标志物FGF23有望成为PEW早期诊断的血清学标志物,Wnt信号通路相关蛋白与PEW的关系需要进一步研究.