The Relationship Between Serum Sclerostin And Bone Mineiral Density And Abdominal Aortic Calcification In Peritoneal Dialysis Patients

Objective: This study is to investigate the bone mineral density(BMD)and AAC in patients with PD,and to explore the correlation between serum sclerostin level and bone mineral density and abdominal aortic calcification.Methods:A cross-sectional study was conducted on patients with continuous ambulatory peritoneal dialysis(continuous ambulatory peritoneal dialysis,CAPD)in our hospital for more than 3 months.The related clinical data were collected and bone mineral density of lumbar vertebrae and femoral neck were measured by dual energy X-ray absorptiometry(Dual Energy X-ray Absorptiometry,DXA),and the T-score was record.The calcification of abdominal aorta was evaluated by lateral abdominal plain film,and the calcification score of abdominal aorta was calculated by(AACs).The level of serum sclerostin was detected by ELISA.SPSS21.0 was used to analyze the statistical correlation between the indexes.Logistic regression analysis was used to analyze the risk factors of low bone mineral density and abdominal aortic calcification in PD patients.The ROC curve was established to evaluate whether serum sclerostin level had predictive value for low bone mineral density and abdominal aortic calcification.Results:1.The average age of 80 patients with PD was 45.7±12.9 years,and the average dialysis age was 30(16,65)months.Osteoporosis was 31.3%,bone loss was 47.5%,and only 21.2% of bone was normal.Bone mineral density in female was lower than that in male(P<0.05),BMD in postmenopausal women was lower than that in non-menopausal women(P<0.05),body mass index was positively correlated with BMD(P<0.05),and alkaline phosphatase(ALP)was negatively correlated with BMD(P< 0.05).Low body mass index(BMI)is an independent risk factor for low bone mineral density in patients with PD.Age,history of diabetes mellitus and different parathyroid hormone levels were not correlated with bone mineral density.The level of serum sclerostin in osteoporosis group was obviously lower than the normal bone group and osteopenia group(P<0.05).2.Abdominal aortic calcification was 41.3%,mild calcification 48.5%,moderate calcification 33.3%,severe calcification in 18.2%.AACs was positively correlated with age,CHOL and LDL,but negatively correlated with serum sclerostin level and medication history of non-calcium-containing phosphorus binders(P<0.05).The degree of calcification of abdominal aorta in diabetic patients was higher than that in non-diabetic patients(P<0.05).3.The results of Logistic regression analysis showed that low level of serum sclerostin was a risk factor for low bone mineral density and abdominal aortic calcification in patients with PD.The sensitivity and specificity of serum sclerostin(AUC)in predicting low bone mineral density were 0.654(P= 0.014)and 53.7% and 79.5%,respectively,when serum sclerostin level(217.40pg/ml)was taken as the cut-off point,and the sensitivity and specificity of serum sclerostin in predicting bone mineral density were 53.7% and 79.5%,respectively.The AUC of serum sclerostin in predicting abdominal aortic calcification was 0.432(P=0.381).Conclusion:Serum sclerostin level was positively correlated with bone mineral density and negatively correlated with abdominal aortic calcification score.Low body mass index and low level of serum sclerostin are independent risk factors for low bone mineral density in patients with PD.Advanced age and low levels of serum sclerostin are independent risk factors for abdominal aortic calcification in patients with PD.The predictive value of serum sclerostin level for low bone mineral density and abdominal aortic calcification needs to be further explored.