| Objective: To study the changes of serum sclerostin levels in CKD stage 1-5 and its correlation with BMD,bone metabolism indexes,calcium and phosphorus metabolism.To investigate the feasibility of sclerostin as a clinical indicator of early response to bone mineral metabolism disorders and its role in the pathogenesis of CKD-MBD.Methods: 115 cases of NDD patients with CKD stage 1-5 admitted to Tangshan Workers Hospital from June 2018 to December 2019 were selected,and another 25 healthy people were selected from Tangshan Workers Hospital as the healthy control group.Clinical data of the patients were collected and the Scr,ALB,Ca,P and ALP were detected by automatic biochemical analyzer.i PTH was detected by automatic chemiluminescence immunoassay,and serum sclerostin and TRACP-5b were detected by enzyme-linked immunosorbent assay.The dual-energy X-ray absorptiometry was used to detect femoral neck bone density(BMD),and Ca was corrected according to ALB.BMI and GFR were calculated according to the formula.The changes of various indicators in the control group and CKD were analyzed,and the relationship between serum sclerostin levels and renal function,BMD and bone mineral metabolism indexes were analyzed.Results: 1.Comparison of clinical data: from the CKD2 stage,sclerostin levels were significantly increased(P<0.05),of which the CKD3 and CKD4 stages were significantly higher than the CKD2 stage(P<0.05),and the CKD5 stage was significantly higher than the CKD4 stage.(P<0.05).From the CKD3 stage,the level of lg[i PTH] increased significantly(P<0.05).Among them,the CKD4 stage was significantly higher than the CKD3 stage(P<0.05),and the CKD5 stage was significantly higher than the CKD4 stage(P<0.05).From the CKD3 stage group,the level of Ca was significantly reduced.Among them,the CKD4 stage was significantly lower than the CKD3 stage(P<0.05),and the CKD5 stage was significantly lower than the CKD4 stage(P<0.05).From the CKD4 stage,the level of P increased significantly(P<0.05),and the CKD5 stage was significantly higher than the CKD4 stage(P<0.05).From the CKD3 stage,the BMD level of the femoral neck was significantly reduced(P<0.05).The CKD4 stage was significantly lower than the CKD3 stage(P<0.05),and the CKD5 stage was significantly lower than the CKD4 stage(P<0.05).From the CKD4 stage,the level of serum ALP was significantly reduced,but here was no significant change in the CKD5 stage compared with the CKD4 stage(P>0.05).From the CKD3 stage,the serum lg[TRACP-5b] level was significantly increased(P<0.05),but there was no significant change in the CKD3,CKD4,and CKD5 stages,and the difference was not statistically significant(P>0.05).2.In patients with CKD,the serum sclerostin level was higher in men than in women,and the difference was statistically significant(P<0.05).3.Correlation analysis showed that BMD of femoral neck was positively correlated with the level of serum sclerostin(P<0.05).4.The levels of sclerostin in CKD patients were positively correlated with lg[TRACP-5b],lg[i PTH],and P(P<0.05),and negatively correlated with GFR and Ca(P <0.05).There was no correlation between serum sclerostin and age,BMI,and ALP(P>0.05).5.Stepwise multiple linear regression analysis showed that levels of CKD patients' sclerostin were closely related to GFR,Ca,and lg[TRACP-5b].Conclusions:1.From the CKD2 stage,the level of serum sclerostin gradually increases with the decline of renal function,and its level changes appear earlier than the BMD of femoral neck,ALP,TRACP-5b,Ca,P,i PTH,and it may serve as an early serological indicator of CKD-MBD.2.The level of sclerostin in NDD patients with stage CKD1-5 were positively correlated with lg[TRACP-5b],lg[i PTH],and P,and negatively correlated with GFR and Ca,suggesting that it may be involved in the occurrence and development of CKD-MBD. |
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