本文選題：維持性血液透析 + Klotho蛋白��； 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究維持性血液透析(MHD)患者血清FGF-23、Klotho蛋白水平與跟骨骨密度(BMD)下降的相關(guān)性,為MHD患者BMD情況的評(píng)估探尋新的標(biāo)志物,為MHD患者骨質(zhì)疏松的干預(yù)治療提供新的靶點(diǎn)。方法:(1)納入69例(男36例,女33例)2016年9月~10月于內(nèi)江市第二人民醫(yī)院血液凈化中心接受MHD治療的終末期腎病患者為病例組(A組),采用超聲定量法檢測(cè)MHD患者跟骨BMD的相關(guān)指標(biāo)——骨質(zhì)指數(shù)(BQI)和T值,進(jìn)一步參照世界衛(wèi)生組織(WHO)推薦的診斷標(biāo)準(zhǔn),將MHD患者分為骨量正常組(A1組)、骨量減少組(A2組)、骨質(zhì)疏松組(A3組);選取36例2016年9月~10月于內(nèi)江市第二人民醫(yī)院體檢中心行健康體檢的,超聲定量法檢測(cè)跟骨BMD正常的健康志愿者為對(duì)照組(B組)。(2)收集入選病例組的性別、年齡、透析治療時(shí)間等一般臨床資料,檢測(cè)肌酐、尿素氮、鈣、磷及PTH等臨床指標(biāo)。(3)采集A組和B組的血液標(biāo)本,采用ELISA法檢測(cè)A、B兩組受試者的血清FGF-23、Klotho蛋白、1,25(OH)2D水平。(4)比較A組和B組研究對(duì)象的血清FGF-23、Klotho、1,25(OH)2D蛋白水平;分析MHD患者血清FGF-23、Klotho蛋白水平與PTH、1,25(OH)2D、Ca、P等臨床指標(biāo)的相關(guān)性;分析MHD患者BMD相關(guān)指標(biāo)——BQI和T值與血清FGF-23、Klotho蛋白水平之間的相關(guān)性;分析MHD患者跟骨BMD下降的相關(guān)影響因素。結(jié)果:(1)69例MHD患者中,跟骨BMD下降的發(fā)生率高達(dá)78%,包括骨量減少者36例(52%),骨質(zhì)疏松者18例(26%)。(2)經(jīng)兩獨(dú)立樣本t檢驗(yàn),A組血清Klotho蛋白水平較B組明顯降低(P0.001),A組血清FGF-23、1,25(OH)2D水平較B組明顯升高(P0.001);進(jìn)一步采用方差分析,A1組、A2組和A3組血清Klotho蛋白水平均明顯低于B組,A1組、A2組和A3組血清FGF-23、1,25(OH)2D水平均明顯高于B組,上述差異均有統(tǒng)計(jì)意義(P0.001)。(3)A1組、A2組、A3組之間,年齡逐漸增大,Klotho蛋白、BQI逐漸降低,骨密度T值的負(fù)值逐漸增大,經(jīng)方差分析,三組之間年齡、Klotho蛋白、BQI、T值4項(xiàng)指標(biāo)的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)經(jīng)pearson相關(guān)性分析:MHD患者血清Klotho蛋白水平與各項(xiàng)血液指標(biāo)均無(wú)相關(guān)性(P0.05);血清FGF-23水平與Ca(r=0.43,P0.001)、P(r=0.36,P=0.002)呈正相關(guān)。(5)經(jīng)pearson相關(guān)性分析:MHD患者BQI與年齡(r=-0.50,P0.001)、治療時(shí)間(r=-0.29,P=0.016)、Klotho蛋白(r=0.58,P0.001)具有相關(guān)性,T值與年齡(r=-0.49,P0.001)、治療時(shí)間(r=-0.28,P=0.017)、Klotho蛋白(r=0.55,P0.001)具有相關(guān)性,年齡、治療時(shí)間與跟骨BMD呈負(fù)相關(guān),血清Klotho蛋白水平與跟骨BMD呈正相關(guān)。(6)采用二分類logisitc回歸分析顯示:年齡增加是MHD患者跟骨BMD下降的危險(xiǎn)因素(OR=1.05,P=0.021),Klotho蛋白降低為MHD患者跟骨BMD下降的危險(xiǎn)因素(OR=2.43,P=0.002)。結(jié)論:(1)MHD患者跟骨BMD下降的發(fā)生率高;(2)MHD患者血清FGF-23與鈣磷代謝有關(guān),但本研究未發(fā)現(xiàn)MHD患者血清FGF-23水平與跟骨骨密度有相關(guān)性;(3)血清Klotho蛋白是MHD患者跟骨BMD下降的保護(hù)性因素;(4)年齡增加是MHD患者跟骨BMD下降的危險(xiǎn)性因素。
[Abstract]:Objective: to study the relationship between the decrease of serum FGF-23 Klotho protein level and calcaneal bone density (BMD) in patients with maintenance hemodialysis (HD), and to explore a new marker for the evaluation of BMD in patients with MHD, and to provide a new target for the intervention therapy of osteoporosis in MHD patients. Methods 69 cases (36 males) were included in the study. From September to October 2016, patients with end-stage nephropathy treated with MHD in the blood purification center of the second people's Hospital of Neijiang City were selected as group A. Bone mass index (BQI) and T value of calcaneal BMD in MHD patients were measured by ultrasound quantitative method. Referring further to the diagnostic criteria recommended by the World Health Organization (WHO), The patients with MHD were divided into normal bone mass group (group A 1), bone mass reduction group (group A 2) and osteoporosis group (group A 3). 36 patients were selected for health examination from September to October 2016 at the physical examination center of the second people's Hospital of Neijiang City. The healthy volunteers with normal calcaneal BMD were collected gender, age, dialysis treatment time and other general clinical data, and creatinine, urea nitrogen, calcium were detected. Serum FGF-23Klotho protein (FGF-23Klotho protein) was measured by ELISA method. The serum FGF-23Klotho protein level was compared between group A and group B (group A and B). To analyze the correlation between serum FGF-23 Klotho protein level and clinical indexes such as PTHF-23 OH2DX CaP, the correlation between BQI and T values and serum FGF-23 Klotho protein level in patients with MHD, and the influencing factors of BMD decrease in calcaneal bone of MHD patients. Results in 69 patients with MHD, The incidence of decrease of BMD in calcaneus was as high as 78%, including 36 cases of osteopenia and 18 cases of osteoporosis. The serum Klotho protein level of group A was significantly lower than that of group B by t test of two independent samples, and the level of OH2D of group A was significantly higher than that of group B (P 0.001). The levels of serum Klotho protein in group A 1 and group A 3 were significantly lower than those in group B, group A 1 and group A 3, respectively, and the levels of serum FGF-23A 2 and group A 3 were significantly higher than those in group B, and the levels of serum Klotho protein in group A 1 and group A 3 were significantly higher than those in group B. All the above differences were statistically significant. The age of BQI of Klotho protein and the negative value of bone mineral density (BMD) increased between A3 group and A3 group (P 0.001), and the variance analysis showed that the BQI of Klotho protein decreased gradually, and the T value of bone mineral density (BMD) increased gradually by ANOVA. The difference of BQI T value of Klotho protein between the three groups was statistically significant (P 0.05). By pearson correlation analysis, there was no correlation between the serum Klotho protein level and the blood indexes in the patients with pearson. There was no correlation between the serum Klotho protein level and the blood index (P 0.05); the level of serum FGF-23 was positively correlated with the serum Klotho protein level and the serum FGF-23 level was positively correlated with the Cahrrn 0.43P 0.001Pr0.36 P0. 002) by the pearson phase. Correlation analysis showed that BQI was correlated with age (r = -0.50) and age (n = 0.50) P 0.001 (r = 0.29) and Klotho protein (r = 0.58 / P 0.001). There was a correlation between T value and age (r = -0.49 / P 0.001, r = -0.28 / 0. 017P = 0. 05 / P 0. 001), and there was a significant correlation between BQI and age (r = 0. 49 ~ 0. 49 / P ~ 0. 001, r = 0. 05 / P 0. 001). Age and duration of treatment were negatively correlated with calcaneal BMD. Serum Klotho protein level was positively correlated with calcaneal BMD. (6) using two classification logisitc regression analysis, the results showed that age increase was the risk factor of decreased calcaneal BMD in MHD patients. Conclusion the incidence of decreased calcaneal BMD in patients with MHD is higher than that in patients with MHD. Serum FGF-23 is related to calcium and phosphorus metabolism. However, there was no correlation between serum FGF-23 level and calcaneal bone mineral density in patients with MHD. (3) Serum Klotho protein was the protective factor of BMD decrease in MHD patients.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692.5

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相關(guān)期刊論文 前10條

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本文編號(hào)：1861020