不同透析模式对患者血清非磷酸化-未羧化的基质gla蛋白水平和血脂分布的影响及与血管钙化的相关性

doi:10.3969/j.issn.1006-5725.2025.22.014

摘要/Abstract

摘要：

目的探讨不同透析模式对维持性血液透析（MHD）患者血清非磷酸化-未羧化的基质gla蛋白（dp-ucMGP）水平、血脂分布及血管钙化的影响，并分析影响MHD患者血管钙化的危险因素。方法选择医院2019年1月至2022年12月收治的87例MHD患者作为研究对象，根据透析模式的不同分为单纯血液透析（HD）组，HD联合血液透析滤过（HD + HDF）组，以及HD、HDF联合血液灌流（HD + HDF + HP）组，每组29例。比较3组血清dp-ucMGP水平、血脂分布及血管钙化情况。根据是否有血管钙化，将患者分为血管钙化组与非血管钙化组，并对可能与MHD血管钙化有关的因素进行单因素分析以及多因素分析。结果 HD组血磷、全段甲状旁腺激素（iPTH）、血清dp-ucMGP、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）均显著高于HD + HDF组及HD + HDF + HP组，高密度脂蛋白胆固醇（HDL-C）显著低于HD + HDF组及HD + HDF + HP组，差异有统计学意义（P < 0.05）。HD + HDF组血磷、iPTH、血清dp-ucMGP均显著高于HD + HDF + HP组，差异有统计学意义（P < 0.05）。与HD组相比，HD + HDF + HP组血管钙化率明显降低（P < 0.05）。与非血管钙化组相比，在MHD透析龄、年龄、脉压差、血磷、血钙、iPTH、LDL-C、TC、dp-ucMGP方面血管钙化组均有明显升高（P < 0.05）。二元logistic回归分析结果显示透析龄、年龄、血磷、血钙、iPTH以及血清dp-ucMGP均是引发MHD血管钙化的独立危险因素（P < 0.05）。结论与单纯HD或HD + HDF透析模式治疗相比，HD + HDF + HP透析模式下MHD患者的血磷、iPTH、血清dp-ucMGP、血脂及血管钙化率更低，但不同透析模式并非是MHD血管钙化的独立影响因素，而透析龄、年龄、血磷、血钙、iPTH以及血清dp-ucMGP则与MHD血管钙化独立相关。

关键词: 维持性血液透析, 透析模式, 非磷酸化-未羧化的基质gla蛋白, 血脂, 血管钙化

Abstract:

Objective To investigate the effects of different dialysis modalities on serum levels of dephosphorylated-uncarboxylated matrix Gla protein （dp-ucMGP）， lipid profiles， and vascular calcification in maintenance hemodialysis （MHD） patients， and to identify the risk factors associated with vascular calcification in this population. Methods A total of 87 MHD patients admitted to the hospital between January 2019 and December 2022 were enrolled as study participants. Based on their dialysis modalities， they were categorized into three groups： the hemodialysis （HD） group， the HD combined with hemodiafiltration （HD + HDF） group， and the HD， HDF combined with hemoperfusion （HD + HDF + HP） group， with 29 patients in each group. The serum dp-ucMGP levels， lipid profiles， and extent of vascular calcification were compared across the three groups. Patients were divided into a vascular calcification group and a non-vascular calcification group based on the presence or absence of vascular calcification. Univariate analyses and multivariate analysis were performed to identify factors potentially associated with vascular calcification in patients undergoing MHD. Results The results demonstrated that the levels of blood phosphorus， intact parathyroid hormone （iPTH）， serum dp-ucMGP， total cholesterol （TC）， triglycerides （TG）， and low-density lipoprotein cholesterol （LDL-C） were significantly higher in the HD group compared to the HD + HDF and HD + HDF + HP groups. Conversely， high-density lipoprotein cholesterol （HDL-C） levels were significantly lower in the HD group than in the other two groups， and all differences were statistically significant （P < 0.05）. The levels of blood phosphorus， iPTH， and serum dp-ucMGP in the HD + HDF group were significantly higher than those in the HD + HDF + HP group， with statistically significant differences （P < 0.05）. Compared with the HD group， the vascular calcification rate in the HD + HDF + HP group was significantly lower （P < 0.05）. In comparison to the non-vascular calcification group， the vascular calcification group exhibited significant increases in MHD dialysis duration， age， pulse pressure， blood phosphorus， blood calcium， iPTH， LDL-C， TC， and dp-ucMGP （P < 0.05）. Binary logistic regression analysis revealed that dialysis vintage， age， serum phosphorus， calcium， iPTH， and serum dp-ucMGP levels were independently associated with a higher risk of vascular calcification in MHD patients （P < 0.05）. Conclusions Compared with the simple HD or HD + HDF dialysis modalities， the HD + HDF + HP regimen is associated with lower levels of serum phosphorus， iPTH， dp-ucMGP， lipids， and vascular calcification prevalence in MHD patients. However， dialysis modality itself was not an independent predictor of vascular calcification. Instead， factors such as dialysis vintage， age， serum phosphorus， calcium， iPTH， and dp-ucMGP were independently associated with vascular calcification in this population.

Key words: maintenance hemodialysis, dialysis mode, non-phosphorylated-uncarboxylated matrix gla protein, blood lipid, vascular calcification

中图分类号:

R459.5

孙婷婷,宋明爱,李建锋. 不同透析模式对患者血清非磷酸化-未羧化的基质gla蛋白水平和血脂分布的影响及与血管钙化的相关性[J]. 实用医学杂志, 2025, 41(22): 3566-3571.

Tingting SUN,Mingai SONG,Jianfeng LI. Study on the effects of different dialysis modes on serum dp⁃ucMGP levels and lipid distribution in patients and their correlation with vascular calcification[J]. The Journal of Practical Medicine, 2025, 41(22): 3566-3571.

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指标	HD组（n = 29）	HD + HDF组（n = 29）	HD + HDF + HP组（n = 29）	F/χ² 值	P值
血钙/（mmol/L）	2.59 ± 0.35	2.52 ± 0.38	2.61 ± 0.39	0.462	0.631
血磷/（mmol/L）	2.31 ± 0.37	2.03 ± 0.34^?	1.82 ± 0.40^?#	12.753	< 0.001
iPTH/（pg/mL）	451.32 ± 40.34	426.06 ± 36.19^?	401.34 ± 37.32^?#	12.552	< 0.001
dp-ucMGP/（ng/mL）	13.76 ± 2.51	11.52 ± 2.28^?	9.98 ± 2.04^?#	20.072	< 0.001
TC/（mmol/L）	4.62 ± 0.53	4.22 ± 0.58^?	4.18 ± 0.51^?	5.873	0.004
TG/（mmol/L）	1.89 ± 0.29	1.56 ± 0.31^?	1.60 ± 0.28^?	10.908	< 0.001
LDL-C/（mmol/L）	2.72 ± 0.38	2.24 ± 0.40^?	2.18 ± 0.37^?	17.272	< 0.001
HDL-C/（mmol/L）	1.12 ± 0.25	1.48 ± 0.27^?	1.49 ± 0.30^?	17.148	< 0.001
血管钙化率/［例（%）］	25（86.21）	20（68.97）	17（58.62）^?	5.501	0.064

项目	血管钙化组（n = 62）	非血管钙化组（n = 25）	χ²/t值	P值
性别（男/女）/例	39/23	14/11	0.357	0.550
年龄/岁	61.34 ± 7.43	46.42 ± 6.95	8.630	< 0.001
透析龄/月	55.20 ± 12.94	37.16 ± 10.38	6.205	< 0.001
BMI/（kg/m²）	21.67 ± 3.12	21.28 ± 2.94	0.536	0.593
SBP/（mmHg）	141.83 ± 15.34	136.59 ± 14.85	1.455	0.149
DBP（mmHg）	71.21±10.68	75.34±9.12	1.699	0.093
PP/（mmHg）	70.62 ± 14.28	61.25 ± 13.45	2.815	0.006
ALP/（U/L）	110.24 ± 22.45	106.27 ± 18.26	0.785	0.435
Scr/（μmol/L）	810.23 ± 158.68	794.24 ± 175.21	0.413	0.681
BUN/（mmol/L）	26.22 ± 6.42	25.86 ± 7.50	0.225	0.822
血钙/（mmol/L）	2.72 ± 0.36	2.21 ± 0.34	6.073	< 0.001
血磷/（mmol/L）	2.18 ± 0.42	1.74 ± 0.36	4.598	< 0.001
iPTH/（pg/mL）	445.32 ± 62.38	378.92 ± 56.22	4.617	< 0.001
ALB/（g/L）	40.21 ± 4.21	41.18 ± 4.75	0.937	0.351
FT/（ng/mL）	285.45 ± 42.55	279.32 ± 38.45	0.625	0.534
TC/（mmol/L）	4.48 ± 0.56	3.99 ± 0.63	3.562	< 0.001
TG/（mmol/L）	1.70 ± 0.32	1.64 ± 0.35	0.770	0.443
LDL-C/（mmol/L）	2.51 ± 0.40	2.06 ± 0.43	4.648	< 0.001
HDL-C/（mmol/L）	1.34 ± 0.28	1.42 ± 0.30	1.182	0.241
dp-ucMGP/（ng/mL）	15.89 ± 2.06	8.05 ± 1.74	16.756	< 0.001
透析模式（HD/HD + HDF/HD + HDF + HP）/例	25/20/17	4/9/12	5.501	0.064
吸烟史/［例（%）］	20（32.26）	7（28.00）	0.151	0.698
饮酒史/［例（%）］	12（19.35）	6（24.00）	0.234	0.628

自变量	B	S_b	Wald χ²	P值	OR	95%CI
年龄	1.234	0.385	8.452	0.004	1.123	1.034 ~ 1.346
透析龄	1.450	0.402	12.356	< 0.001	1.087	0.012 ~ 1.298
血钙	1.127	0.346	15.672	< 0.001	4.582	1.452 ~ 15.224
血磷	0.987	0.312	14.356	< 0.001	3.874	1.376 ~ 13.302
iPTH	0.882	0.294	10.234	< 0.001	2.034	1.173 ~ 8.375
dp-ucMGP	1.235	0.362	13.987	< 0.001	2.402	1.256 ~ 11.408