摘要目的 探讨不同Ca2+浓度腹膜透析液对腹膜透析患者血清胎球蛋白A水平和颈动脉粥样硬化的影响,以及两者间的关系.方法 2008年1月至2010年1月本科室收治30例终末期肾病(ESRD)患者,按完全随机法分为生理钙透析液组及普通钙透析液组,分别使用生理钙透析液(Ca2+浓度1.25 mmol/L)和普通钙透析液(Ca2+浓度1.75 mmol/L)进行腹膜透析治疗并随访观察1年.治疗前后检测患者血清高敏C反应蛋白(hs-CRP)、白蛋白(Alb)、甲状旁腺素(PTH)、钙磷乘积(Ca×P)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、胎球蛋白A水平,以及超声检测颈动脉斑块进展情况.10例体检的健康正常人作为健康对照组,检测其血清胎球蛋白A水平.结果 治疗前ESRD组与健康对照组血清胎球蛋白A水平分别为(276.20± 17.0)mg/L和(372.10±18.5)mg/L,ESRD组较健康对照组显著降低(P＜0.01).治疗前胎球蛋白A高水平组患者心血管事件发生率低于胎球蛋白A低水平组(P＜0.05).治疗1年后,生理钙透析液组患者颈动脉斑块进展显著慢于普通钙透析液组(P＜0.05).Logistic回归分析显示颈动脉斑块进展与治疗前后血清胎球蛋白A水平变化值(△fetuin-A)有关联(β=0.320,P＜0.01).结论 生理钙透析液能够通过稳定血清胎球蛋白A水平延缓动脉粥样硬化进展,减少腹膜透析患者心血管事件的发生.

abstractsObjective To investigate the influences of different calcium concentrations in dialysate on serum fetuin-A and carotid atherosclerosis in patients with end stage renal disease (ESRD) who underwent peritoneal dialysis (PD),and examine the association between serum fetuin-A and atherosclerosis.Methods Thirty ESRD patients undergoing PD in our department between January 2008 and January 2010 were enrolled in this study.They were randomly divided into two groups in 1-year followed-up PD with physiological calcium dialysate( [Ca2+]=1.25 mmol/L) or standard calcium dialysate( [Ca2+]=1.75 mmol/L).At baseline and end of the study,serum high sensitivity C-reactive protein (hs-CRP),albumin (Alb),parathyroid hormone (PTH),Ca×P,total cholesterol (TC),triglyceride (TG),high density lipoprotein (HDL),low density lipoprotein (LDL),and fetuin-A were determined in these patients.The carotid plaque was also detected by the ultrasonography before and after the investigation.Ten healthy subjects were enrolled as the healthy control group and their serum fetuin-A was detected as well.Results At baseline,the level of serum fetuin-A was significandy lowered in ESRD patients than that in healthy controls [ (276.20± 17.0) mg/L vs (372.10± 18.5 ) mg/L,P＜0.01 ],and cardiovascular events were less likely to occur in patients with higher serum fetuin-A as compared to those with lower serum fetuin-A (P＜0.05).After dialysis for 12 months,progression of carotid atherosclerotic lesions was significantly slower in the patients using physiological calcium dialysate as compared to those using the standard calcium dialysate (P＜0.05).Logistic regression analysis indicated that change of serum fetuin-A after PD (△ fetuin-A) was independently associated with progression of carotid atherosclerotic lesions (β=0.320,P＜0.01).Conclusions Physiological calcium dialysate can slow down the progression of atherosclerotic lesions through stabilizing serum fetuin-A level,thereby reducing cardiovascular events in patients on PD.