Relationship Of Serum Tumor Necrosis Factor And Matrix Gla Protein Levels With Cardiac Valve Calcification In Maintenance Hemodialysis Patients

Objective: To detect the levels of tumor necrosis factor alpha(TNF-?)and matrix Gla protein(MGP)in maintenance hemodialysis(MHD)patients,and then analyze the correlation of these indexes with other clinical indexes and discuss the relations of TNF-? or MGP with cardiac valve calcification(CVC)further for providing theoretical basis of the fundamental research in the prevention and treatment of CVC.It is a new strategy to find a new therapeutic target.Methods: 66 MHD patients in Department of Nephrology,the Second affiliated hospital of Anhui medical university from July 2016 to October 2016 were included into the case group,and 33 age-and gender-matched healthy volunteers recorded in health examination center were included as healthy control group.The basic information of height,weight,dialysis duration were recorded,and laboratory indexes of hemoglobin,albumin,triglycerides,cholesterol,calcium,phosphorus,parathyroid hormone,alkaline phosphatase,C-reactive protein were collected.The case group were divided into CVC group and non-CVC group based on whether or not the participants had CVC which detected by color Doppler echocardiography.The levels of TNF-? in serum samples and the concentrations of MGP were detected by enzyme-linked immunosorbent assay(ELISA).Results: 66 patients with MHD were included as case group in this research,and the primary diseases were 32 chronic glomerulonephritis(48.48%),9 hypertensive nephropathy(13.64%),7 diabetic nephropathy(10.61%),7 polycystic kidney(10.61%),3 lupus nephritis(4.55%)and 8 other cases(12.12%).Besides,30 patients(45.45%)had confirmed CVC.31 age-,gender-,and BMI-matched healthy volunteers were incorporated into this research,and no patients with confirmed CVC.Compared with healthy people,the probability of suffering CVC has a significantly higher level in patients with MHD.(1)Compared with healthy group,TNF-? increases significantly in case group(P<0.001).And in case group,the levels of TNF-? in CVC patients are much higher than the patients without CVC.(2)Compared with healthy group,MGP declines significantly in case group(P<0.001).And in case group,the levels of MGP in CVC patients are much lower than the patients without CVC(P=0.001).(3)Through the comparison of age,the group with CVC are much older than the group without CVC(P=0.009).Through the comparison of dialysis duration,the group with CVC are much longer than the group without CVC(P=0.031).Through the comparison of gender,BMI,the difference has no statistical significance(P>0.05).Through the comparison of laboratory indexes including hemoglobin,cholesterol,albumin,parathyroid hormone,triglycerides,C-reactive protein,blood-calcium,blood-phosphorus,alkaline phosphatase,the difference of two groups have no statistical significance(P>0.05).(4)The results of correlation study show that the level of serum MGP is inverse correlative with age,alkaline phosphatase and TNF-?(P < 0.05),and it has no significant correlation with dialysis duration,triglycerides,parathyroid hormone,cholesterol,hemoglobin,calcium,phosphorus and calcium-phosphorus product.(5)Logistic regression analysis shows that dialysis duration and high levels of serum TNF-? are independent risk factors(P<0.05 and P<0.01,respectively)for CVC while high levels of MGP are protective factors for CVC(P<0.05).Conclusions: The level of serum TNF-? increases,together with MGP declines in the patients with MHD,especially the ones with CVC.And the level of MGP has a negative correlation with age,alkaline phosphatase and TNF-?.Otherwise,the level of serum TNF-? and MGP may be related with CVC,Logistic regression analysis result shows that higher TNF-? is an independent risk factor for CVC while higher MGP is a protective factor for CVC.The further fundamental research is necessary for discovering the concrete mechanism.