2023 年第 2 期 第 18 卷

维持性血液透析患者血清前蛋白转化酶枯草溶菌素9及鸢尾素水平与颈动脉钙化的关系

Relationship of serum proprotein convertase subtilisin/Kexin type 9 and irisin levels to carotid artery calcification in patients with maintenance hemodialysis

作者：王萌吴振杨欢曹青

英文作者：Wang Meng Wu Zhen Yang Huan Cao Qing

单位：中国人民解放军联勤保障部队第九〇四医院肾内科，无锡214000

英文单位：Department of Nephrology the 904th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army Wuxi 214000 China

关键词：维持性血液透析；颈动脉钙化；前蛋白转化酶枯草溶菌素9；鸢尾素

英文关键词：Maintenancehemodialysis;Carotidarterycalcification;Proproteinconvertasesubtilisin/Kexintype9;Irisin

• 摘要：

• 目的 探讨维持性血液透析（MHD）患者血清前蛋白转化酶枯草溶菌素9（PCSK9）、鸢尾素水平与颈动脉钙化（CAC）的关系。方法 选取中国人民解放军联勤保障部队第九〇四医院2020年1月至2022年4月收治的147例MHD患者作为MHD组，根据颈动脉是否存在钙化斑块将患者分为CAC组（82例）和无CAC组（65例）。选取同期58例本院体检健康者为对照组。收集MHD患者临床资料，检测MHD组及对照组血清PCSK9、鸢尾素水平。采用多因素Logistic回归方法分析MHD患者CAC的影响因素，受试者工作特征（ROC）曲线分析血清PCSK9、鸢尾素水平对MHD患者CAC的诊断价值。结果 MHD组血清PCSK9水平高于对照组［249.33（195.77,285.00）μg/L比112.25（77.79，136.40）μg/L］，鸢尾素水平低于对照组［（52±9）μg/L比（72±11）μg/L］，差异均有统计学意义（均P＜0.001）。CAC组年龄、透析时间、血清低密度脂蛋白胆固醇、血磷、全段甲状旁腺激素（iPTH）、PCSK9水平均大于/长于/高于无CAC组，鸢尾素水平低于无CAC组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析显示，透析时间、血磷、iPTH、PCSK9为MHD患者CAC的独立危险因素，鸢尾素为独立保护因素（均P＜0.05）。ROC曲线分析显示，血清PCSK9、鸢尾素水平单独与联合诊断MHD患者CAC的曲线下面积分别为0.795、0.809、0.893。结论 MHD患者血清PCSK9水平升高，鸢尾素水平降低，二者与MHD患者CAC密切相关，可作为MHD患者CAC的辅助诊断指标。

• Objective To investigate the relationship of serum proprotein convertase subtilisin/Kexin type 9 (PCSK9) and irisin levels to carotid artery calcification (CAC) in patients with maintenance hemodialysis (MHD). Methods  Totally 147 patients with MHD (MHD group) were selected in the 904th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army from January 2020 to April 2022. Patients were divided into CAC group (82 cases) and non CAC group (65 cases) according to whether the carotid artery was calcified or not. Another 58 healthy people with physical examination during the same period were selected as the control group. Clinical data of MHD patients were collected and serum PCSK9 and irisin levels of MHD group and control group were detected. Multivariate Logistic regression method was used to analyze the factors influencing CAC in MHD patients and the diagnostic value of serum PCSK9 and irisin levels on CAC in MHD patients was analyzed using the receiver operating characteristic (ROC) curve. Results  The serum PCSK9 level in MHD group was higher than that in control group［249.33（195.77,285.00）μg/L vs 112.25（77.79，136.40）μg/L］, and irisin level in MHD group was lower than that in control group ［（52±9）μg/L vs （72±11）μg/L］(both P<0.001). Compared to non CAC group, the age, dialysis time, serum low-density lipoprotein cholesterol, blood phosphorus, intact parathyroid hormone (iPTH) and PCSK9 levels were greater/longer/higher in CAC group, and the serum irisin level was lower in CAC group (all P<0.05). Multivariate Logistic regression analysis showed that dialysis time, blood phosphorus, iPTH and PCSK9 were independent risk factors and irisin was an independent protective factor for CAC in MHD patients (all P< 0.05). ROC curve analysis showed that the area under the curve for serum PCSK9 and irisin levels alone and in combination to diagnose CAC in MHD patients was 0.795, 0.809 and 0.893 respectively. Conclusions  Serum PCSK9 level increases and irisin level decreases in MHD patients, which are closely related to CAC in MHD patients and can be used as auxiliary diagnostic indicators of CAC in MHD patients.