The Relationship Between Serum Semaphorin 3A Level And Osteoporosis And Calcium And Phosphorus Metabolism In ESRD Patients

Objective: To observe the relationship between serum Semaphorin3 A level and bone mineral density,serum calcium and phosphorus and other bone metabolic indexes in patients with end-stage renal disease.Method: A total of 61 patients with ESRD were selected from April 2021 to November 2021 in the Department of Nephrology,affiliated Hospital of Qinghai University(including 32 patients who had not yet received dialysis and 29 patients who had received hemodialysis in our hospital for more than 3 months)and 32 healthy persons in the physical examination center.The general data and related laboratory indexes of all subjects were collected,and the expression levels of serum Semaphorin3 A and 1,25-dihydroxyvitamin D3 were measured by enzyme-linked immunosorbent assay.Part one: According to whether the patients with ESRD received maintenance hemodialysis or not,they were divided into ESRD non-dialysis group and ESRD hemodialysis group,and the healthy persons in the physical examination center served as the control group.The general data of all subjects(sex,age,smoking,medication:whether to take calcitriol capsule / pallidol injection,lanthanum carbonate chewable tablets / carbonate silveram tablets,etc.)and related laboratory indexes(renal function,bone mineral density,alkaline phosphatase,etc.)were collected.The changes of the above indexes and the correlation between serum Semaphorin3 A and bone mineral density among the three groups were counted and analyzed.part two: According to whether ESRD patients were treated with calcitriol capsule/ pallidol injection and lanthanum carbonate chewable tablets / Sveram carbonate tablets,all ESRD patients were divided into medication group and non-medication group.The related indexes of bone metabolism such as calcium and phosphorus were collected.The changes of the above indexes between the two groups were counted and analyzed,and the correlation between the serum Semaphorin3 A level and the collected bone metabolism indexes was analyzed.Result:Part one:1.The utilization rate of drugs regulating calcium and phosphorus metabolism in ESRD hemodialysis group was significantly higher than that in ESRD non-dialysis group.(P<0.05).2.There were significant differences in serum Semaphorin3 A,DHVD3,BUN,Scr,SUA and bone mineral density among the three groups(P<0.05).The serum Semaphorin3 A level and bone mineral density in ESRD hemodialysis group and nondialysis group were significantly lower than those in control group(P<0.05),while the serum DHVD3 level in ESRD hemodialysis group and control group was significantly higher than that in ESRD non-dialysis group(P<0.05).3.The results of correlation analysis showed that there was a correlation between serum Semaphorin3 A and bone mineral density.part two:1.The levels of serum Ca,P and DHVD3 in ESRD medication group were significantly different from those in ESRD non-medication group.(P<0.05).The levels of serum DHVD3 and Ca in ESRD medication group were significantly higher than those in ESRD non-medication group,(P<0.05),while the level of serum P in ESRD medication group was significantly lower than that in ESRD non-medication group(P<0.05).There was no significant difference in CT,i PTH,ALP levels and bone mineral(P>0.05).2.The results of correlation analysis showed that there was no significant correlation between serum Semaphorin 3A and the levels of Ca,P,i PTH,CT,ALP and DHVD3 in ESRD patients.Conclusion:1.The level of serum Semaphorin 3A in patients with ESRD was significantly lower than that in healthy controls,and hemodialysis could not clear serum Semaphorin3 A in patients with ESRD.2.The level of serum Semaphorin3 A was correlated with bone mineral density,but not with the levels of Ca,P,i PTH,CT,ALP and DHVD3 in patients with ESRD,suggesting that Semaphorin 3A may participate in the process of bone metabolism in patients with ESRD through non-calcium and phosphorus metabolic pathway.3.The use of vitamin D analogues,vitamin D receptor activators and phosphorus binders can regulate the levels of serum Ca and P in patients with ESRD,but have no significant effect on bone mineral density.